Contenuto dell'articolo principale
Abstract
Introduzione: Il rispetto degli standard presenti in letteratura durante il triage di persone vittima di trauma, permette di sfruttare in modo ottimale le risorse di cui dispongono i Trauma Center e ne definisce il livello di qualità ed efficienza. In caso contrario si può assistere ad over o under-triage. Fino a questo momento, nella realtà oggetto di studio e nella letteratura nazionale, non era disponibile alcuna misurazione di efficienza ed efficacia circa il relativo triage del paziente traumatico; pertanto l’obiettivo primario è ottenere dati relativi alle percentuali di over-triage e under-triage circa l’attivazione del Trauma Team (TT) nell’ASST di Monza-Ospedale San Gerardo. Metodo: Il disegno di studio è osservazionale retrospettivo monocentrico. Risultati: Nell’Ospedale San Gerardo, nel periodo esaminato, si è prodotto un over-triage del 62,9% ed un under-triage, relativo al medesimo anno, dell’1,7%. Discussione: Utilizzare un algoritmo decisionale di attivazione del TT è alla base dell’intero processo assistenziale della persona vittima di trauma. Questo strumento dovrebbe riportare il giusto compromesso tra sensibilità elevata (under-triage → 0, accettando il rischio di avere un over-triage elevato) e specificità elevata (over-triage minimo ma con possibilità di creare un più elevato under-triage). Non vi è tuttavia condivisione di tali algoritmi che risultano disomogenei nelle diverse realtà come è ancora disomogenea la definizione di trauma maggiore, del TT e della sua composizione. Conclusioni: Abbiamo misurato le percentuali di over e under triage relative all’attivazione del TT dell’ASST di Monza. Ci si aspetta di poterle monitorarle periodicamente, quali possibili indicatori di qualità d’assistenza al cittadino, ponendosi come mission, al pari dell’efficacia, di incrementare l’efficienza.
Parole chiave
Dettagli dell'articolo
Riferimenti
- ACI, Aiscat; Unione Petrolifera Italiana; Ministero dello Sviluppo Economico; Istat. (2016) Incidenti Stradali Anno 2016 Disponibile 30/10/2018 da: Available from: https://www.istat.it/it/files/2018/07/Incidenti-stradali_2016.pdf
- Airey C.M., Chell S.M., Rigby A.S., Tennant A., Connelly J.B. (2001) The epidemiology of disability and occupation handicap resulting from major traumatic injury. Disabil Rehabil. 23(12): 509–15
- American College of Surgeons - Committee on Trauma. (2014) Resources for Optimal Care of the Injured Patient (edizione 6). Chicago, IL 60611-3211. ISBN 978-0-9846699-8-1
- Baker S.P., O'Neill B., Haddon W. Jr., Long W.B. (1984) The injury severity: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 14: 187-196
- Baxt W.G., Jones G., Fortlage D. (1990) The Trauma Triage Rule: a new, resource- based approach to the prehospital identification of major trauma victims. Ann Emerg Med. 19:1401–1406
- Braun B.J., Holstein J., Fritz T., Veith N.T., Herath S., Mörsdorf P., Pohlemann T. (2016) Polytrauma in the elderly: a review. EFORT Open Rev. 1:146-151
- Cameron A.P., Gabbe J.B., Smith K., Mitra B.(2014) Triaging the right patient to the right place in the shortest time. British Journal of Anaesthesia. 113(2): 226-33
- Champion H.R., Copes W.S., Sacco W.J., Lawnick M.M., Keast S.L., Bain L.W. Jr., Flanagan M.E., Frey C.F. (1990) The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 30:1356–1365
- Chiara O., Gordini G., Nardi G., Sanson G., (2012) Trauma Care. La cura definitiva del trauma maggiore. Elsevier SRL, Milano. ISBN 978-88-214-2696-4
- D.d.g. 1 ottobre 2012 - n. 8531. Determinazioni in merito all’organizzazione di un sistema integrato per l’assistenza al trauma maggiore.
- Davis J.W., Dirks R.C., Sue L.P., Kaups K.L. (2017) Attempting to validate the overtriage/undertriage matrix at a Level I trauma center. J Trauma Acute Care Surg. 83(6
- Dinh M.M., Bein K.J., Oliver M., Veillard A.S., Ivers R. (2014) Refining the trauma tri- age algorithm at an Australian major trauma centre: derivation and internal validation of a triage risk score. European Journal of Trauma Emergency and Surgery. 40(1): 67–74.
- Giannoudis P.V., Harwood P.J., Court-Brown C., Pape H.C. (2009) Severe and multiple trauma in older patients: incidence and mortality. Injury. 40(4): 362-367.
- Hamada S.R., Gauss T., Duchateau F.X., Truchot J., Harrois A., Raux M., Duranteau J., Mantz J., Paugam-Burtz C. (2014) Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients. J Trauma Acute Care Surg. 76(6):1476-83
- Lehmann R., Brounts L., Lesperance K., Eckert M., Casey L., Beekley A., Martin M. (2009) A simplified set of trauma triage criteria to safely reduce overtriagea Prospective study. Arch Surg. 144(9):853-858
- Lerner E.B. (2006) Studies evaluating current field triage: 1966–2005. Prehospital Em Care, 10: 303–306
- Lindera F., Holmberga L., Eklofb H., Bjorcka M., Juhlina C., Mani K. (2018) Better compliance with triage criteria in trauma would reduce costs with maintained patient safety. European Journal of Emergency Medicine
- Nogueira L., Domingues C., Campos a., Mdeand R.M. Sousa. (2008) Ten years of new injury severity score (NISS): is it a possible change? Rev Lat Am Enfermagem, 16: 314-319
- Ochsner M.G., Schmidt J.A., Rozycki G.S., Champion H.R. (1995) The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe? J Trauma. 39(5):971-7
- Overly F.L., Wills H., Valente J.H. (2014) 'Not just little adults' - a pediatric trauma primer. Rhode Island Medical Journal (2013). 97(1):27-30.
- Palmer CS, Gabbe BJ, Cameron PA. (2015) Defining major trauma using the 2008 Abbreviated Injury Scale. Injury. 47(1): 109-15
- Phillips J.A., Buchman T.G. (1993) Optimizing prehospital triage criteria for trauma team alerts. J Trauma. 34(1):127-32
- Raynaud L., Borne M., Coste S., DabanJ.L., Tourtier J.P. (2010) Triage protocol: both undertriage and overtriage need to be evaluated. J Trauma. 69(4): 998
- Rupprecht H., Heppner H.J., Wohlfart K., Turkoglu A. (2017) The geriatric polytrauma: Risk profile and prognostic factors. Ulus Travma Acil Cerrahi Derg. 23(2):156–162.
- Sasser S.M., Hunt R.C., Sullivent E.E., Wald M.M., Mitchko J., Jurkovich G.J., Henry M.C., Salomone J.P., Wang S.C., Galli R.L. (2009) Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep, 58(RR-1): 1–35
- Sethi D., Racioppi F., Baumgarten I., Vida P. (2006) Injuries and violence in Europe: why they matter and what can be done. Violence and Injury Prevention WHO European Centre for Environment and Health. WHO Regional Office for Europe, Roma
- Shawhan M.D., Derek P.M., Vay D.O., Linda Casey R.N., Tara Spears R.N., Scott R., Steele M.D., Matthew J., Martin M.D. (2015) A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study. J Am Surg. 209, 856-863
- Stoica B., Paun S., Tanase I., Negoi I., Chiotoroiu A., Beuran M. (2016) Probability of Survival Scores in Different Trauma Registries: A Systematic Review. Chirurgia. 111(2):115-9
- Tignanelli C.J., Vander Kolk W., Mikhail J.N., Delano M.J., Hemmila M.R. (2017) Non-compliance with ACS-COT recommended criteria for full trauma team activation is associated with undertriage deaths. J Trauma Acute Care Surg
- Trunkey D. (1983) Trauma. Accidental and intentional injuries account for more years of life lost in the US than cancer and heart disease. Scientific American. 249: 20-7
- Uleberg O., Vinjevoll O.P., Eriksson U. (2007) Overtriage in trauma. What are the causes? Acta Anaesthesiol Scand. 51:1178–83
- Wilkinson Judith M. (2003) Processo infermieristico e pensiero critico (edizione 3). Casa Editrice Ambrosiana. ISBN 978-88-0818570-9
- Wiseman T., Foster K., Curtis K. (2013) Mental Health following traumatic physical injury: an integrated literature review. Injury. 11: 1383–90.
- World Health Organization; 2015. Essential trauma care project. Disponible 10/10/2018 da: http://www.who.int/violence_injury_prevention/services/traumacare/en.pdf
- World Health Organization; 2017. Guidelines for trauma quality improvement programmes. Disponibile 05/06/2018 da: http://whqlibdoc.who.int/publication/2017/9789241597746_eng.pdf
Riferimenti
ACI, Aiscat; Unione Petrolifera Italiana; Ministero dello Sviluppo Economico; Istat. (2016) Incidenti Stradali Anno 2016 Disponibile 30/10/2018 da: Available from: https://www.istat.it/it/files/2018/07/Incidenti-stradali_2016.pdf
Airey C.M., Chell S.M., Rigby A.S., Tennant A., Connelly J.B. (2001) The epidemiology of disability and occupation handicap resulting from major traumatic injury. Disabil Rehabil. 23(12): 509–15
American College of Surgeons - Committee on Trauma. (2014) Resources for Optimal Care of the Injured Patient (edizione 6). Chicago, IL 60611-3211. ISBN 978-0-9846699-8-1
Baker S.P., O'Neill B., Haddon W. Jr., Long W.B. (1984) The injury severity: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 14: 187-196
Baxt W.G., Jones G., Fortlage D. (1990) The Trauma Triage Rule: a new, resource- based approach to the prehospital identification of major trauma victims. Ann Emerg Med. 19:1401–1406
Braun B.J., Holstein J., Fritz T., Veith N.T., Herath S., Mörsdorf P., Pohlemann T. (2016) Polytrauma in the elderly: a review. EFORT Open Rev. 1:146-151
Cameron A.P., Gabbe J.B., Smith K., Mitra B.(2014) Triaging the right patient to the right place in the shortest time. British Journal of Anaesthesia. 113(2): 226-33
Champion H.R., Copes W.S., Sacco W.J., Lawnick M.M., Keast S.L., Bain L.W. Jr., Flanagan M.E., Frey C.F. (1990) The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 30:1356–1365
Chiara O., Gordini G., Nardi G., Sanson G., (2012) Trauma Care. La cura definitiva del trauma maggiore. Elsevier SRL, Milano. ISBN 978-88-214-2696-4
D.d.g. 1 ottobre 2012 - n. 8531. Determinazioni in merito all’organizzazione di un sistema integrato per l’assistenza al trauma maggiore.
Davis J.W., Dirks R.C., Sue L.P., Kaups K.L. (2017) Attempting to validate the overtriage/undertriage matrix at a Level I trauma center. J Trauma Acute Care Surg. 83(6
Dinh M.M., Bein K.J., Oliver M., Veillard A.S., Ivers R. (2014) Refining the trauma tri- age algorithm at an Australian major trauma centre: derivation and internal validation of a triage risk score. European Journal of Trauma Emergency and Surgery. 40(1): 67–74.
Giannoudis P.V., Harwood P.J., Court-Brown C., Pape H.C. (2009) Severe and multiple trauma in older patients: incidence and mortality. Injury. 40(4): 362-367.
Hamada S.R., Gauss T., Duchateau F.X., Truchot J., Harrois A., Raux M., Duranteau J., Mantz J., Paugam-Burtz C. (2014) Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients. J Trauma Acute Care Surg. 76(6):1476-83
Lehmann R., Brounts L., Lesperance K., Eckert M., Casey L., Beekley A., Martin M. (2009) A simplified set of trauma triage criteria to safely reduce overtriagea Prospective study. Arch Surg. 144(9):853-858
Lerner E.B. (2006) Studies evaluating current field triage: 1966–2005. Prehospital Em Care, 10: 303–306
Lindera F., Holmberga L., Eklofb H., Bjorcka M., Juhlina C., Mani K. (2018) Better compliance with triage criteria in trauma would reduce costs with maintained patient safety. European Journal of Emergency Medicine
Nogueira L., Domingues C., Campos a., Mdeand R.M. Sousa. (2008) Ten years of new injury severity score (NISS): is it a possible change? Rev Lat Am Enfermagem, 16: 314-319
Ochsner M.G., Schmidt J.A., Rozycki G.S., Champion H.R. (1995) The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe? J Trauma. 39(5):971-7
Overly F.L., Wills H., Valente J.H. (2014) 'Not just little adults' - a pediatric trauma primer. Rhode Island Medical Journal (2013). 97(1):27-30.
Palmer CS, Gabbe BJ, Cameron PA. (2015) Defining major trauma using the 2008 Abbreviated Injury Scale. Injury. 47(1): 109-15
Phillips J.A., Buchman T.G. (1993) Optimizing prehospital triage criteria for trauma team alerts. J Trauma. 34(1):127-32
Raynaud L., Borne M., Coste S., DabanJ.L., Tourtier J.P. (2010) Triage protocol: both undertriage and overtriage need to be evaluated. J Trauma. 69(4): 998
Rupprecht H., Heppner H.J., Wohlfart K., Turkoglu A. (2017) The geriatric polytrauma: Risk profile and prognostic factors. Ulus Travma Acil Cerrahi Derg. 23(2):156–162.
Sasser S.M., Hunt R.C., Sullivent E.E., Wald M.M., Mitchko J., Jurkovich G.J., Henry M.C., Salomone J.P., Wang S.C., Galli R.L. (2009) Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep, 58(RR-1): 1–35
Sethi D., Racioppi F., Baumgarten I., Vida P. (2006) Injuries and violence in Europe: why they matter and what can be done. Violence and Injury Prevention WHO European Centre for Environment and Health. WHO Regional Office for Europe, Roma
Shawhan M.D., Derek P.M., Vay D.O., Linda Casey R.N., Tara Spears R.N., Scott R., Steele M.D., Matthew J., Martin M.D. (2015) A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study. J Am Surg. 209, 856-863
Stoica B., Paun S., Tanase I., Negoi I., Chiotoroiu A., Beuran M. (2016) Probability of Survival Scores in Different Trauma Registries: A Systematic Review. Chirurgia. 111(2):115-9
Tignanelli C.J., Vander Kolk W., Mikhail J.N., Delano M.J., Hemmila M.R. (2017) Non-compliance with ACS-COT recommended criteria for full trauma team activation is associated with undertriage deaths. J Trauma Acute Care Surg
Trunkey D. (1983) Trauma. Accidental and intentional injuries account for more years of life lost in the US than cancer and heart disease. Scientific American. 249: 20-7
Uleberg O., Vinjevoll O.P., Eriksson U. (2007) Overtriage in trauma. What are the causes? Acta Anaesthesiol Scand. 51:1178–83
Wilkinson Judith M. (2003) Processo infermieristico e pensiero critico (edizione 3). Casa Editrice Ambrosiana. ISBN 978-88-0818570-9
Wiseman T., Foster K., Curtis K. (2013) Mental Health following traumatic physical injury: an integrated literature review. Injury. 11: 1383–90.
World Health Organization; 2015. Essential trauma care project. Disponible 10/10/2018 da: http://www.who.int/violence_injury_prevention/services/traumacare/en.pdf
World Health Organization; 2017. Guidelines for trauma quality improvement programmes. Disponibile 05/06/2018 da: http://whqlibdoc.who.int/publication/2017/9789241597746_eng.pdf