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Journal of Trauma and Injury 2014;27(4):126-132.
Measure of Agreement between Prehospital EMS Personnel and Hospital Staffs using Guidelines for Field Triage of Injured Patients
Dae Kon Kim, Ki Jeong Hong, Hyun Noh, Won Pyo Hong, Yu Jin Kim, Sang Do Shin, Ju Ok Park
1Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Korea. juok.park@gmail.com
2Department of Emergency Medicine, Seoul National University College of Medicine Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea.
3Department of Emergency Medicine Inje University College of Medicine Inje University Seoul Paik Hospital, Korea.
4National Emergency Medical Center, Korea.
5Department of Emergency Medicine Seoul National University Bundang Hospital Seoul National University College of Medicine, Korea.
외상환자의 병원 전 및 병원단계 중증도 평가의 일치도
김대곤, 홍기정1, 노현2 홍원표3, 김유진4, 신상도, 박주옥
서울대학교병원 응급의학과, 1서울특별시 보라매병원 응급의학과, 2인제대학교 서울백병원 응급의학과, 3중앙응급의료센터, 4분당서울대학교병원 응급의학과
Received: 22 July 2014   • Revised: 31 August 2014   • Accepted: 11 September 2014
Abstract
PURPOSE
The field trauma triage for injured patients is essential for trauma care system. In this study, agreement of patient evaluation between by prehospital EMS personnel and by hospital staffs and the appropriateness of prehospital triage were evaluated.
METHODS
This observational study was conducted from September to October 2012 for 5 weeks. During this period, EMT evaluated patient's severity according to guideline for field triage and recorded. Same guideline was applied in 26 hospitals for patients with EMS use. Kappa statistics were used to measure agreement for each item of guideline. Finally, over-triage and under-triage rate of EMT were calculated.
RESULTS
During study period, total 3,106 patients were transferred to 26 hospital emergency departments with EMS use. Kappa statistics for "vital signs" items were 0.45 for mentality lower than V and 0.44 for systolic blood pressure lower than 90 mmHg as a moderate agreement. In "anatomy of injury" items Kappa statistics were very low. In "mechanism of injury" items Kappa statistics were 0.28 for high-rise fall down and 0.27 for high energy traffic accident but in other items Kappa statistics were very low. 362 patients (12.0%) were over-triaged and 281 patients (9.3%) were under-triaged.
CONCLUSION
Field triage can be applied but need to evaluate and modify in order to become accurate and sensitive for decision of transportation.
Key Words: Wound and injuries; Triage; Multiple trauma; Emergency medical services; Trauma center
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