This study was undertaken to determine factors that influence the access to trauma centre care of paediatric and geriatric patients injured in motor vehicle collisions (MVCs). Hospital discharge records for 1997 were obtained from the Pennsylvania Health Care Cost Containment Council (USA) and were analysed. Of cases with an Injury Severity Score (ISS) of more than 15, 52.6% of elderly cases and 48.6% of paediatric cases were transported to and received their care in non- trauma centre hospitals. These very high "mis-triage" rates could not be explained by differences in injury severity, body region or population density. In order to assess potential out-of-hospital factors, a file containing matched records from Emergency Medical Services (EMS) calls and hospita1 discharges from MVC cases across Pennsylvania for the year 1996 was constructed and analysed. There were no significant vital signs differences between trauma centre and non-trauma centre cases, with the single exception of the Glasgow Coma Scale score, for both the paediatric and geriatric age groups. A re-evaluation of out-of-hospital trauma triage is needed. (Author/publisher)
Samenvatting