Choi, Kang Kook
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Jang, Myung Jin
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Lee, Min A
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Lee, Gil Jae
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Yoo, Byungchul
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Park, Youngeun
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Lee, Jung Nam
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
Purpose: Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC fi...
Purpose: Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea. Methods: This retrospective cohort study evaluated trauma patients who presented at the authors' regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step. Results: Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism-of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively. Conclusions: The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.
Purpose: Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea. Methods: This retrospective cohort study evaluated trauma patients who presented at the authors' regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step. Results: Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism-of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively. Conclusions: The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.
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문제 정의
Therefore, the aim of this study was to evaluate suitability of the CDC field triage and KTAS criteria for cases of major trauma, which was defined by an injury severity score (ISS) of >15 [9].
This study was designed to evaluate the suitability of the trauma triage systems that are currently used in Korea, including the CDC field triage system and the KTAS.
제안 방법
The KTAS criteria were as follows: KTAS ≤1, KTAS ≤2, KTAS ≤3, KTAS ≤4, and KTAS ≤5, and then the undertriage and overtriage rates of each categorization were evaluated. Receiver operating characteristic (ROC)curves were constructed, and the area under the curve (AUC) was evaluated for each step of the criteria. ROC curves were also constructed for the separate components of each step (physiologic criteria, anatomic criteria, mechanism-of-injury criteria, and special considerations).
The KTAS criteria were as follows: KTAS ≤1, KTAS ≤2, KTAS ≤3, KTAS ≤4, and KTAS ≤5, and then the undertriage and overtriage rates of each categorization were evaluated.
대상 데이터
Patients with backgrounds of drowning, choking, hanging, sexual assault, and burns were excluded. A total of 1,008 trauma patients were ultimately enrolled in this study.
This retrospective cohort study evaluated trauma patients who presented at the Gil Medical Center which is the regional trauma center of Incheon, Korea from January 1 to May 7, 2017 using the Korean Trauma Data Base (KTDB). Patients with backgrounds of drowning, choking, hanging, sexual assault, and burns were excluded.
성능/효과
Based on our results, we conclude that it is better to omit step IV of the CDC triage system because the overtriage rate markedly increased from 59.4% in step III to 78.9% in step IV, and, moreover, the undertriage rate also increased from 4.5% to 5.3% (Table 1, Fig. 1). Fig.
In conclusion, the CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV.
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