Petri R W, Dyer A, Lumpkin J
Division of Emergency Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Prehosp Disaster Med. 1995 Jan-Mar;10(1):24-9. doi: 10.1017/s1049023x00041625.
To test the hypothesis that a prehospital time threshold (PhTT) exists that when exceeded, significantly increases the mortality of trauma patients transported directly from the scene of injury to a trauma center rather than to the closest hospital.
Review of data contained within the Illinois Trauma Registry encompassing the period from fall 1989 through spring 1991.
A total of 5,215 injured persons with an Injury Severity Score (ISS) > 10, cared for in an Illinois level-I or -II trauma center outside of the city of Chicago.
Injury severity expressed as ISS, scene time (ST), transport time (TrT), total emergency medical services time (TEMST), and outcome were determined for each patient. Patients were stratified into groups on the basis of ISS.
Patient outcomes were significantly different statistically between ISS groups (p < 0.001, chi 2). Mean ST and TEMST, but not TrT, were significantly different statistically between ISS groups (p < 0.001, analysis of variance). Lower ISS was associated with longer times. Mean ST, TrT, and TEMST were significantly different statistically between survivors and nonsurvivors (p < 0.001, two-sample t-tests). Survival was associated with longer times. Each of the mean times remained significantly different between survivors and nonsurvivors after controlling for severity of injury (p < 0.001, two-way analysis of variance).
No PhTT beyond which time patient transport to the closest hospital would have decreased mortality was identifiable, because no prehospital time < 90 minutes exerted a significant adverse effect upon survival.
检验以下假设，即存在一个院前时间阈值（PhTT），一旦超过该阈值，会显著增加直接从受伤现场转运至创伤中心而非最近医院的创伤患者的死亡率。
回顾伊利诺伊创伤登记处1989年秋季至1991年春季期间的数据。
共有5215名损伤严重度评分（ISS）>10的受伤者，在芝加哥市外的伊利诺伊州一级或二级创伤中心接受治疗。
确定每名患者的损伤严重程度（以ISS表示）、现场时间（ST）、转运时间（TrT）、急诊医疗服务总时间（TEMST）以及转归情况。根据ISS将患者分层分组。
ISS组间患者转归在统计学上有显著差异（p<0.001，卡方检验）。ISS组间平均ST和TEMST在统计学上有显著差异，但TrT无显著差异（p<0.001，方差分析）。较低的ISS与较长时间相关。幸存者与非幸存者之间的平均ST、TrT和TEMST在统计学上有显著差异（p<0.001，两样本t检验）。生存与较长时间相关。在控制损伤严重程度后，幸存者与非幸存者之间的每个平均时间仍有显著差异（p<0.001，双向方差分析）。
未发现存在一个能使患者转运至最近医院可降低死亡率的PhTT，因为没有<90分钟的院前时间对生存产生显著不利影响。
