Cummings G, O'Keefe G
Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Emerg Med. 2000 Apr;18(3):349-54. doi: 10.1016/s0736-4679(99)00227-9.
This prospective cohort study was performed from 1994 to 1996 to compare the impact of scene disposition on prehospital and hospital costs incurred by rural trauma patients transported to a trauma center by helicopter or ground ambulance. The study included all rural adult injury victims who arrived at the tertiary trauma center by ambulance within 24 h of injury. Inclusion criteria consisted of inpatient admission or death in the emergency department, and any traumatic injury except burns. Data collected included mortality, mode of transport, Injury Severity Score (ISS), and costs from impact to discharge or death. Of 105 study patients, 52 initially went to a rural hospital, while 53 went directly to the trauma center. There was no significant difference in survival in the two groups. The ISS was significantly higher for patients taken directly to the trauma center from the scene. The ISS of trauma patients transported from the rural hospital was highest for patients sent by ground transport. The prehospital transport costs were significantly more for patients transported to a rural hospital first. The costs incurred at the trauma center were highest for those patients transported directly from the scene. Many severely injured patients were initially transported to a rural hospital rather than directly to the trauma center. At both the scene and rural hospital, consistent use of triage criteria appeared to be lacking in determining the severity of injury, appropriate destination, and mode of transport for trauma patients. Since no significant difference in prehospital helicopter and ground transport costs was demonstrated, the decision on mode of transport should be in the best interest of patient care.
这项前瞻性队列研究于1994年至1996年进行，旨在比较现场处置对通过直升机或地面救护车转运至创伤中心的农村创伤患者的院前和医院费用的影响。该研究纳入了所有在受伤后24小时内通过救护车抵达三级创伤中心的农村成年受伤受害者。纳入标准包括住院治疗或在急诊科死亡，以及除烧伤以外的任何创伤性损伤。收集的数据包括死亡率、运输方式、损伤严重程度评分（ISS）以及从受伤到出院或死亡的费用。在105名研究患者中，52人最初前往农村医院，而53人直接前往创伤中心。两组的生存率没有显著差异。直接从现场送往创伤中心的患者的ISS显著更高。从农村医院转运的创伤患者中，通过地面运输的患者ISS最高。首先送往农村医院的患者的院前运输费用显著更高。直接从现场转运的患者在创伤中心产生的费用最高。许多重伤患者最初被送往农村医院而非直接送往创伤中心。在现场和农村医院，在确定创伤患者的损伤严重程度、合适的目的地和运输方式时，似乎都缺乏对分诊标准的一致使用。由于院前直升机和地面运输费用没有显示出显著差异，运输方式的决定应该以患者护理的最佳利益为出发点。
