Ruchholtz S, Zintl B, Nast-Kolb D, Waydhas C, Lewan U, Kanz K G, Schwender D, Pfeifer K J, Schweiberer L
Department of Surgery, Klinikum Innenstadt, Ludwig-Maximilians-University of Munich, Germany.
Injury. 1998 Mar;29(2):115-29. doi: 10.1016/s0020-1383(97)00150-2.
A trauma algorithm representing the guidelines for the management of emergency treatment of severe blunt trauma was implemented at our institution in 1994. By comparison of two prospectively recorded cohorts of multiply injured patients, the clinical efficacy of these guidelines was analysed. The algorithm cohort comprised 74 patients over the period January 1994 to June 1996, and the Control cohort 126 patients over the period April 1988 to December 1993. To evaluate procedural quality of early clinical trauma management, nine criteria were applied. After implementation of the algorithm there was an improvement in all parameters reflected by a significant reduction of missed injuries and important time savings. Mortality rates in the cohorts were calculated after subdivision into three groups (I-III) with moderate (ISS: 18-24), high (ISS: 25-49) and very high (ISS: 50-75) injury severity. All cohort subgroups were comparable with respect to ISS values, age, initial loss of consciousness (GCS) and shock rate. In all subgroups of the algorithm cohort mortality rates were reduced: group I: 0 versus 20 per cent (p < 0.05); group II: 8 versus 24 per cent (p < 0.05); group III: 40 versus 71 per cent. Improvements in both therapeutic process and outcome were observed after implementation of the trauma algorithm.
1994年，我们机构实施了一种创伤治疗流程，该流程代表了严重钝性创伤紧急治疗的管理指南。通过对两组前瞻性记录的多发伤患者队列进行比较，分析了这些指南的临床疗效。治疗流程队列包括1994年1月至1996年6月期间的74例患者，对照组包括1988年4月至1993年12月期间的126例患者。为了评估早期临床创伤管理的程序质量，应用了九条标准。实施该治疗流程后，所有参数均有改善，漏诊损伤显著减少，时间大幅节省。将队列患者按损伤严重程度分为三组（I - III组），中度（损伤严重度评分：18 - 24）、高度（损伤严重度评分：25 - 49）和极高度（损伤严重度评分：50 - 75），计算各组死亡率。所有队列亚组在损伤严重度评分值、年龄、初始意识丧失（格拉斯哥昏迷评分）和休克发生率方面具有可比性。治疗流程队列的所有亚组死亡率均降低：I组：0%对20%（p < 0.05）；II组：8%对24%（p < 0.05）；III组：40%对71%。实施创伤治疗流程后，观察到治疗过程和结果均有改善。
