Pepe P E, Maio R F
Departments of Medicine, Surgery, and Pediatrics, Baylor College of Medicine, Houston, TX.
Prehosp Disaster Med. 1993 Jan-Mar;8(1 Suppl):25-34.
For the past two decades, prehospital trauma care has been addressed almost generically in terms of the related approaches to epidemiology, research, and management. However, evolving directions in research have helped emergency medical services (EMS) practitioners to delineate more focused treatment strategies according to the mechanisms of injury, anatomic involvement, and the patient's clinical condition. Recent studies in the areas of trauma-associated circulatory arrest, severe blunt head injury, and post-traumatic hemorrhage following penetrating truncal injury suggest that current standard approaches to patient care should be reconsidered. In turn, this need for re-examination of trauma management strategies calls for the development of appropriate evaluation tools within EMS systems. Proper research design is dependent upon several key issues including: 1) the type of study (system study versus examination of a specific intervention); 2) the population under study; 3) physiological and anatomical scoring method; 4) prospective definitions of interventions and meaningful outcome variables (both morbidity and mortality); 5) relative outcome compared to known standards; and 6) prospective determination of statistical requirements.
在过去二十年中，院前创伤护理在流行病学、研究和管理等相关方法方面几乎是一般性的探讨。然而，研究方向的不断发展帮助急诊医疗服务（EMS）从业者根据损伤机制、解剖学累及情况和患者的临床状况制定更具针对性的治疗策略。近期在创伤相关循环骤停、严重钝性头部损伤以及穿透性躯干损伤后创伤后出血等领域的研究表明，当前患者护理的标准方法应重新审视。反过来，这种对创伤管理策略重新审视的需求促使在EMS系统内开发适当的评估工具。恰当的研究设计取决于几个关键问题，包括：1）研究类型（系统研究与特定干预措施的检查）；2）研究人群；3）生理和解剖学评分方法；4）干预措施和有意义的结局变量（发病率和死亡率）的前瞻性定义；5）与已知标准相比的相对结局；以及6）统计要求的前瞻性确定。
