Rogers F B, Osler T M, Shackford S R, Cohen M, Camp L, Lesage M
University of Vermont, College of Medicine, Burlington 05401, USA.
J Trauma. 1999 Feb;46(2):328-33. doi: 10.1097/00005373-199902000-00022.
To determine the characteristics and outcome of transferred trauma patients in a rural setting.
We conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures.
RTTPs (39.4%) spent an average of 182+/-139 minutes at the outlying hospital and 72+/-42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1+/-8.5; Acute Physiology and Chronic Health Evaluation II 16.2+/-5.8; Revised Trauma Score 7.44+/-1.1) than the trauma patients admitted directly (ISS 7.9+/-5.3; Acute Physiology and Chronic Health Evaluation II 13.1+/-6.3; Revised Trauma Score 7.8+/-0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473).
Rural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.
确定农村地区创伤转诊患者的特征及治疗结果。
我们对一家农村一级创伤中心的所有创伤入院病例进行了病例对照研究，以考察在3.5年期间（1993 - 1996年），直接入院的创伤患者与在外院初步稳定病情后转诊而来的创伤患者（RTTP）之间的情况。我们将院前时间、损伤严重度评分（ISS）、半数致死损伤严重度评分（LD50ISS，即50%患者死亡时的ISS）、修订创伤评分、生存概率、急性生理与慢性健康状况评价II（APACHE II）以及观察到的生存率作为主要结局指标。
RTTP（39.4%）在外院平均停留182±139分钟，转运至创伤中心的时间为72±42分钟。RTTP组中头部/颈部损伤患者及多发伤患者的比例更高。RTTP的损伤程度比直接入院的创伤患者更严重（ISS 11.1±8.5；APACHE II 16.2±5.8；修订创伤评分7.44±1.1），而直接入院患者的相应指标为（ISS 7.9±5.3；APACHE II 13.1±6.3；修订创伤评分7.8±0.4；p < 0.05）。然而，两组的LD50ISS相同（ISS = 35）。以死亡作为因变量进行逻辑回归分析时，ISS和年龄均有显著影响（p = 0.0001），但转诊状态无显著影响（p = 0.473）。
农村创伤中心接收的RTTP比例较高。这些RTTP的损伤严重程度和病情严重程度高于直接入院的创伤患者。农村地区在外院进行初步稳定病情后再转诊至创伤中心的创伤救治模式对死亡率没有不利影响。
