Holcomb John B, Niles Sarah E, Miller Charles C, Hinds Denise, Duke James H, Moore Frederick A
University of Texas Health Sciences Center, Houston, TX 77030, USA.
Mil Med. 2005 Jan;170(1):7-13. doi: 10.7205/milmed.170.1.7.
The ability to accurately triage trauma patients can be difficult in the prehospital environment. Prehospital trauma scoring systems have been developed with a goal of determining which patients should be transported immediately to a trauma center, thus benefiting from critical personnel and resource-intensive lifesaving interventions (LSIs). A resource-based endpoint, LSIs, therefore might be the optimal endpoint of prehospital triage scoring and could be used to determine where patients are transported. We hypothesized that simple physiologic data available immediately upon scene arrival would prove predictive of the need for a LSI.
Trauma patients transported from the injury scene by helicopter were eligible for entry into the study. Prehospital physiologic data and interventions were timed and recorded by flight medical personnel, whereas hospital vital signs, injuries, and interventions were prospectively recorded from the inpatient records. The motor component of the Glasgow Coma Scale was used as an indicator of neurologic function. LSIs were procedures deemed lifesaving by a multidisciplinary panel of trauma experts.
Physiologic data were collected from August 2001 to February 2002. Data were collected for 216 random patients transported by the Life Flight helicopter service. There were no differences between LSI and non-LSI patients in age, gender, or transport time, and 80 patients underwent 197 LSIs. The mean age was 33 +/- 17 years, 73% of patients were male, 90% suffered blunt injury, the injury severity score was 14 +/- 9, hypotension (systolic blood pressure of < 90 mm Hg) was present in 14% of cases, and the mortality rate was 6%. Penetrating injury and increasing injury severity score were associated with LSI. Univariate analysis of the physiologic data immediately available in the field revealed that SBP of < 90 mm Hg, motor score of < 6, delayed capillary refill, and increasing pulse were significantly associated with a LSI. However, multivariate analysis revealed that only SBP of < 90 mm Hg and motor score of < 6 were associated with a LSI. When both variables were abnormal, 95% of patients required a LSI; when both variables were normal, 21% of patients required a LSI.
The presence of hypotension or decreased motor score was correlated with the need for LSIs. However, normotensive patients with normal motor scores still frequently required LSIs. Optimal discrimination of this group of patients will require new analytic approaches.
在院前环境中，准确分诊创伤患者可能具有挑战性。院前创伤评分系统的开发旨在确定哪些患者应立即转运至创伤中心，从而受益于关键人员和资源密集型的救生干预措施（LSIs）。因此，基于资源的终点——LSIs可能是院前分诊评分的最佳终点，可用于确定患者的转运地点。我们假设，到达现场后立即获得的简单生理数据可预测是否需要进行LSI。
由直升机从受伤现场转运的创伤患者符合纳入本研究的条件。院前生理数据和干预措施由飞行医务人员记录时间，而医院生命体征、损伤情况和干预措施则从住院记录中前瞻性记录。格拉斯哥昏迷量表的运动部分用作神经功能指标。LSIs是由多学科创伤专家小组认定为救生的程序。
生理数据收集时间为2001年8月至2002年2月。收集了由生命飞行直升机服务转运的216例随机患者的数据。LSI患者和非LSI患者在年龄、性别或转运时间上无差异，80例患者接受了197次LSIs。平均年龄为33±17岁，73%的患者为男性，90%为钝性损伤，损伤严重程度评分为14±9，14%的病例存在低血压（收缩压<90mmHg），死亡率为6%。穿透性损伤和损伤严重程度评分增加与LSI相关。对现场立即可得的生理数据进行单因素分析显示，收缩压<90mmHg、运动评分<6、毛细血管再充盈延迟和脉搏增加与LSI显著相关。然而，多因素分析显示，只有收缩压<90mmHg和运动评分<6与LSI相关。当两个变量均异常时，95%的患者需要进行LSI；当两个变量均正常时，21%的患者需要进行LSI。
低血压或运动评分降低与需要进行LSIs相关。然而，血压正常且运动评分正常的患者仍经常需要进行LSIs。对这组患者进行最佳鉴别将需要新的分析方法。
