Implementation of Prehospital Trauma Triage Guidelines Decreases Mortality of Trauma Patients
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概要
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Background: Prehospital trauma triage is one of the most essential components of a trauma system. The American College of Surgeons (ACS) field triage guidelines were implemented in suburban Osaka where a trauma system has not yet been established, and effectiveness of the guidelines for regional trauma care was evaluated. Methods: The ACS trauma triage guidelines were applied to the emergency medical service beginning in January 2001, and trauma patients meeting the step 1 to step 3 criteria were to be transported directly to our institution, which functions as a level I-II trauma center. Data was obtained for blunt trauma patients admitted during the period January 1999 through December 2000 and for those admitted during after implementation of the guidelines, during the period September 2001 through August 2003. Transport data, injury severity and mortality were compared between the two groups. Results: The number of blunt trauma patients admitted to our institution increased from 270 (January 1999-December 2001) to 501 after implementation of the guidelines (September 2001-August 2003). There was no statistically significant difference between the two blunt trauma groups in the direct transport time from the trauma scene to our institution. The number of minor trauma (ISS<15) patients increased from 130 to 272, and the number of major trauma (ISS≥15) patients increased from 167 to 229. With implementation of the guidelines, the rate of overtriage increased from 37.6% to 55.9%, but the rate of undertriage decreased from 23.4% to 14.8% (p<0.05). The mortality of patients with an ISS of 30-44 and of ISS 45-59 decreased from 39.3% to 30.8% and from 63.6% to 47.6%, respectively, but these decreases were not statistically significant. The mortality of patients with an ISS of 15-29 decreased significantly from 21.9% to 11.5% (p<0.05). Conclusion: Implementation of the ACS trauma triage guidelines was useful in directing major trauma patients to our institution without an increase in transport time, and it improved survival of these patients. We conclude that implementation of the ACS trauma triage guidelines can effectively improve trauma care in suburban areas of Japan where trauma systems have not yet been established.
- 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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