三种检伤分类方法对地震伤重症伤员的应用价值  

The value of three triage methodologies for critically ill patients in earthquake mass casualty

作　　者：邵子伦 宋承润 王司琪 胡海[3,4] SHAO Zilun;SONG Chengrun;WANG Siqi;HU Hai(West China School of Public Health,Sichuan University,Chengdu 610041,P.R China;West China School of Medicine,Sichuan University,Chengdu 610041,P.R China;Emergency Office of West China Hospital,Sichuan University,Chengdu 610041,P.R China;Comprehensive Emergency Medical Rescue Base,Chengdu 610041,P.R China)

机构地区：[1]四川大学华西公共卫生学院,成都610041 [2]四川大学华西临床医学院,成都610041 [3]四川大学华西医院应急办公室,成都610041 [4]紧急医学救援综合基地(四川)办公室,成都610041

出　　处：《中国循证医学杂志》2021年第7期760-765,共6页Chinese Journal of Evidence-based Medicine

基　　金：中国科学院战略性先导科技专项项目(编号:XDA23090502)。

摘　　要：目的START(simple triage and rapid transport)是目前国内外大型群体伤事件中应用较为广泛的一种检伤分类方法,MPTT(modified physiological triage tool)和MPTT-24(modified physiological triage tool-24)是新兴出现的检伤分类方法,但其在地震等自然灾害中运用的可行性和准确性缺乏数据支撑。本研究旨在评估这三种检伤分类方法在地震伤重症伤员中的应用价值。方法对四川大学华西医院地震伤员数据库收集的36604例伤员采用START、MPTT和MPTT-24进行分类,以死亡、收治入ICU情况为标准,比较三种检伤分类方法的受试者工作特征曲线的曲线下面积,并对比三种检伤分类方法在不同标准下的灵敏度与特异度,与ISS(injury severity score)评分进行相关性分析。结果最终纳入数据库记录的30806例伤员,以死亡为标准,START、MPTT和MPTT-24的曲线下面积分别为0.711、0.775、0.686;以是否进入ICU为标准,校正偏倚后START、MPTT和MPTT-24的曲线下面积分别为0.579、0.618、0.603;START、MPTT和MPTT-24与ISS评分的相关系数分别为0.041、0.087、0.115。结论MPTT法对于地震伤重症患者评估的应用价值优于START和MPTT-24。Objective Currently,simple triage and rapid transport(START)is widely used as a method to evaluate the severity of mass casualty events in a disaster.Modified physiological triage tool(MPTT)and modified physiological triage tool-24(MPTT-24)are newly introduced triage methodologies that may offer improvements over START.However,the feasibility and accuracy of these two methods cannot be adequately assessed without sufficient data support,whether in earthquakes or other disasters.Our study aimed to analyze the value of the three triage methodologies in mass casualty events due to earthquakes.Methods A total of 36604 injured patients from the West China Hospital database were evaluated using START,MPTT and MPTT-24,respectively.The triage methodologies were then evaluated based on death and ICU acceptance,using the area under the receiver-operator curve(AUC).The sensitivity and specificity of the three methodologies were compared under different standards and correlations with the injury severity score(ISS)were analyzed.Results For deaths,the AUCs for the triage methodologies were 0.711,0.775 and 0.686 for START,MPTT,and MPTT-24,respectively.For ICU acceptance,the AUCs of the triage methodologies after correction for bias were 0.579,0.618 and 0.603.The correlation coefficients of the triage methodologies and ISS score were 0.041,0.087,and 0.115.Conclusions MPTT is superior to START and MPTT-24 in the evaluation of critically ill patients in mass casualty events caused by earthquakes.

关 键 词：检伤分类法 START MPTT MPTT-24 ISS 

分 类 号：R129[医药卫生—环境卫生学]