Efficacy and Limitations of Prehospital Triage and Destination Decisions by Emergency Personnel.
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概要
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BACKGROUND: Emergency hospitals in Japan are classified according to a 3-tiered system. Prehospital triage of emergency patients and decisions by emergency personnel regarding the destination of patients are key processes in emergency medical services. Emergency personnel must therefore be competent at performing prehospital triage. OBJECTIVES: To study the efficacy and limitations of prehospital triage in Tokyo by examining clinical outcome. DESIGN: A retrospective observational study. METHODS: All patients who were transported to Keio University Hospital (a secondary and tertiary emergency medical center) by ambulances belonging to Tokyo Fire Department over a 3-year period beginning in 1997 were identified. The patients were divided into two groups according to their prehospital triage status (critical or noncritical) and by their clinical category (intrinsic or extrinsic cause). The prehospital triage status of the patients was then compared with the patient's outcome in the emergency room (ER) (Death in ER, Admission to ICU/CCU, or discharge from hospital). In addition, the accuracy of prehospital triage status and clinical category as independent predictors of 30-day mortality in patients admitted to the ICU/CCU was examined using the Cox proportional hazards model. RESULTS: Overall 15620 consecutive patients were identified in the present study. In prehospital triage, 1152 patients (7.4%) were judged as being critical. According to the ER diagnosis, 9587 (61.4%) were classified as having intrinsic causes and 5763 (36.9%) as having extrinsic causes. Although patients with a critical prehospital triage status and intrinsic causes were less frequent than those with extrinsic causes (odds ratio=0.52, 95% CI: 0.46 to 0.59), more patients with intrinsic causes were admitted to the ICU/CCU (odds ratio=3.07, 95% CI: 2.61 to 3.61). Among the patients admitted to the ICU/CCU, the cumulative 30-day mortality rate for patients designated as critical during prehospital triage was higher than that of noncritical patients (27.4% and 12.1%, respectively; p<0.0001). The 30-day mortality rate of patients with intrinsic causes was higher than that of those with extrinsic causes (17.6% and 6.0%, respectively; p=0.0003). A multivariate correlation analysis also demonstrated that prehospital triage status and intrinsic cause were independent predictors of mortality (relative risk=3.28, 95% CI: 2.37 to 4.54; relative risk=3.03, 95% CI: 1.52 to 5.88, respectively). CONCLUSION: Current prehospital triage policies provide acceptable assessments of short-term survival in patients who are subsequently admitted to the ICU/CCU. However, prehospital triage has a significant bias towards assigning patients with intrinsic causes a lower triage status than what is desirable.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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