Accuracy of Trauma on Scene Triage Screening Tool (Shock Index, Reverse Shock Index Glasgow Coma Scale and National Early Warning Score) to Predict the Severity of Emergency Department Triage: A Retrospective Cross-Sectional Study.
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引用次数: 2
Abstract
Introduction: Prehospital trauma care includes on-scene assessments, essential treatment, and facilitating transfer to an appropriate trauma center to deliver optimal care for trauma patients. While the Simple Triage and Rapid Treatment (START), Revised Triage Sieve (rTS), and National Early Warning Score (NEWS) tools are user-friendly in a prehospital setting, there is currently no standardized on-scene triage protocol in Thailand Emergency Medical Service (EMS). Therefore, this study aims to evaluate the precision of these tools (SI, rSIG, and NEWS) in predicting the severity of trauma patients who are transferred to the emergency department (ED).
Methods: This study was a retrospective cross-sectional and diagnostic research conducted on trauma patients transferred by EMS to the ED of Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand, from January 2015 to September 2022. We compared the on-scene triage tool (SI, rSIG, and NEWS) and ED triage tool (Emergency Severity Index) parameters, massive transfusion protocol (MTP), and intensive care unit (ICU) admission with the area under ROC (univariable analysis) and diagnostic odds ratio (multivariable logistic regression analysis). The optimal cut-off threshold for the best parameter was determined by selecting the value that produced the highest area under the ROC curve.
Results: A total of 218 patients were traumatic patients transported by EMS to the ED, out of which 161 were classified as ESI levels 1-2, while the remaining 57 patients were categorized as levels 3-5 on the ESI triage scale. We found that NEWS was a more accurate triage tool to discriminate the severity of trauma patients than rSIG and SI. The area under the ROC was 0.74 (95% CI 0.70-0.79) (OR 18.98, 95% CI 1.06-337.25), 0.65 (95% CI 0.59-0.70) (OR 1.74, 95% CI 0.17-18.09) and 0.58 (95% CI 0.52-0.65) (OR 0.28, 95% CI 0.04-1.62), respectively (P-value <0.001). The cut point of NEWS to discriminate ESI levels 1-2 and levels 3-5 was >6 points.
Conclusion: NEWS is the best on-scene triage screening tool to predict the severity at the emergency department, massive transfusion protocol (MTP), and intensive care unit (ICU) admission compared with other triage tools SI and rSIG.
院前创伤护理包括现场评估、基本治疗和促进转移到适当的创伤中心,为创伤患者提供最佳护理。虽然简单分诊和快速治疗(START)、修订分诊筛(rTS)和国家预警评分(NEWS)工具在院前环境中是用户友好的,但泰国紧急医疗服务(EMS)目前没有标准化的现场分诊协议。因此,本研究旨在评估这些工具(SI、rSIG和NEWS)在预测转至急诊科(ED)的创伤患者严重程度方面的准确性。方法:本研究对2015年1月至2022年9月泰国曼谷大学附属三级医院Ramathibodi医院急诊急诊急诊急诊的创伤患者进行回顾性横断面和诊断研究。我们比较了现场分诊工具(SI、rSIG和NEWS)和急诊科分诊工具(急诊严重程度指数)参数、大量输血方案(MTP)和重症监护病房(ICU)入院与ROC下面积(单变量分析)和诊断优势比(多变量logistic回归分析)。通过选择在ROC曲线下产生最大面积的值来确定最佳参数的最佳截止阈值。结果:218例急诊创伤患者均为EMS转运至急诊科,其中ESI 1-2级161例,其余57例为ESI 3-5级。我们发现NEWS是一种比rSIG和SI更准确的区分创伤患者严重程度的分类工具。ROC下面积分别为0.74 (95% CI 0.70-0.79) (OR 18.98, 95% CI 1.06-337.25)、0.65 (95% CI 0.59-0.70) (OR 1.74, 95% CI 0.17-18.09)和0.58 (95% CI 0.52-0.65) (OR 0.28, 95% CI 0.04-1.62) (p值6点)。结论:与其他分诊工具SI和rSIG相比,NEWS是预测急诊科严重程度、大量输血方案(MTP)和重症监护病房(ICU)入院的最佳现场分诊筛查工具。