苏格兰城市与农村创伤结局研究。

Scottish urban versus rural trauma outcome study.

作者信息

McGuffie A Crawford, Graham Colin A, Beard Diana, Henry Jennifer M, Fitzpatrick Michael O, Wilkie Stewart C, Kerr Gary W, Parke Timothy R J

机构信息

Crosshouse Hospital, Kilmarnock, Scotland.

出版信息

J Trauma. 2005 Sep;59(3):632-8.

DOI:

PMID:16361906

Abstract

BACKGROUND

Outcome following trauma and health care access are important components of health care planning. Resources are limited and quality information is required. We set the objective of comparing the outcomes for patients suffering significant trauma in urban and rural environments in Scotland.

METHOD

The study was designed as a 2 year prospective observational study set in the west of Scotland, which has a population of 2.58 million persons. Primary outcome measures were defined as the total number of inpatient days, total number of intensive care unit days, and mortality. The participants were patients suffering moderate (ISS 9-15) and major (ISS>15) trauma within the region. The statistical analysis consisted of chi square test for categorical data and Mann Whitney U test for comparison of medians.

RESULTS

There were 3,962 urban (85%) and 674 rural patients (15%). Urban patients were older (50 versus 46 years, p = 0.02), were largely male (62% versus 57%, p = 0.02), and suffered more penetrating traumas (9.9% versus 1.9%, p < 0.001). All prehospital times are significantly longer for rural patients (p < 0.001), include more air ambulance transfers (p < 0.001), and are characterized by greater paramedic presence (p < 0.001). Excluding neurosurgical and spinal injuries transfers, there was a higher proportion of transfers in the rural major trauma group (p = 0.002). There were more serious head injuries in the urban group (p = 0.04), and also a higher proportion of urban patients with head injuries transferred to the regional neurosurgical unit (p = 0.037). There were no differences in length of total inpatient stay (median 8 days, p = 0.7), total length of stay in the intensive care unit (median two days, p = 0.4), or mortality (324 deaths, moderate trauma, p = 0.13; major trauma, p = 0.8).

CONCLUSION

Long prehospital times in the rural environment were not associated with differences in mortality or length of stay in moderately and severely injured patients in the west of Scotland. This may lend support to a policy of rationalization of trauma services in Scotland.

摘要

背景

创伤后的结果及医疗保健的可及性是医疗保健规划的重要组成部分。资源有限，因此需要高质量的信息。我们设定的目标是比较苏格兰城市和农村地区严重创伤患者的治疗结果。

方法

本研究设计为一项在苏格兰西部开展的为期2年的前瞻性观察性研究，该地区人口为258万。主要结局指标定义为住院总天数、重症监护病房总天数和死亡率。研究对象为该地区中度（损伤严重度评分[ISS]9 - 15）和重度（ISS>15）创伤患者。统计分析包括对分类数据的卡方检验和对中位数进行比较的曼-惠特尼U检验。

结果

共有3962名城市患者（85%）和674名农村患者（15%）。城市患者年龄更大（50岁对46岁，p = 0.02），男性比例更高（62%对57%，p = 0.02），且穿透性创伤更多（9.9%对1.9%，p < 0.001）。农村患者的所有院前时间均显著更长（p < 0.001），包括更多空中救护转运（p < 0.001），且其特点是护理人员在场比例更高（p < 0.001）。排除神经外科和脊柱损伤转运后，农村重度创伤组的转运比例更高（p = 0.002）。城市组严重头部损伤更多（p = 0.04），且头部受伤的城市患者转至区域神经外科病房的比例也更高（p = 0.037）。住院总时长（中位数8天，p = 0.7）、重症监护病房总时长（中位数2天，p = 0.4）或死亡率（324例死亡，中度创伤，p = 0.13；重度创伤，p = 0.8）均无差异。