Høyer C Christian S, Christensen Erika F, Andersen Niels T
Department of Anaesthesiology and Intensive Care, Trauma Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
Eur J Emerg Med. 2006 Jun;13(3):156-9. doi: 10.1097/01.mej.0000206192.46954.16.
Severe injury is the leading cause of death among the young. Trauma systems have improved management of the severely injured and increased survival rates, but there is no level-1 evidence of advanced prehospital trauma care. Advanced prehospital trauma care prolongs on-scene time, which may imply a risk of significant delay in definitive trauma care. The aim of this study was to evaluate on-scene time and influence of (1) the presence of an anaesthesiologist on-scene, (2) prehospital intubation, (3) entrapment, and (4) injury severity.
A cohort of registry-based patients brought to Aarhus Trauma Centre. Data were consecutively reported. On-scene time was defined as the time from vehicle arrival to departure. Severe injury is defined by an injury severity score >15. The study was conducted over the period 1998-2000; only patients brought primarily to the trauma centre were included. Statistical tests used include chi, Kruskal-Wallis, Wilcoxon's rank sum and Spearman's rho.
Seven hundred and forty-one patients triaged to Aarhus Trauma Centre from which we obtained all information in 596 cases constituted the study group. In 472 cases, an anaesthesiologist was present. On-scene times, median and 95% confidence interval, were as follows: entire study group (n=596) 15.5 min (15-17); ambulance only: 14.0 min (12-15); anaesthesiologist present, no intubation, no entrapment: 15.0 min (14-16); intubation, no entrapment: 21.5 min (16-27); entrapment, no intubation: 21.5 min (17-25); both intubation and entrapment: 22.0 min (16-36).
The presence of an anaesthesiologist prolonged the median on-scene time by 1 min and in cases of prehospital intubation by 7.5 min. This result was no different from the prolongation caused by entrapment.
重伤是年轻人死亡的主要原因。创伤系统改善了对重伤患者的管理并提高了生存率，但尚无关于高级院前创伤护理的一级证据。高级院前创伤护理会延长现场停留时间，这可能意味着确定性创伤护理会出现显著延迟的风险。本研究的目的是评估现场停留时间以及（1）现场麻醉医生的存在、（2）院前插管、（3）被困情况和（4）损伤严重程度的影响。
一组登记在案的患者被送往奥胡斯创伤中心。数据连续报告。现场停留时间定义为从车辆到达至离开的时间。重伤定义为损伤严重度评分>15。研究在1998 - 2000年期间进行；仅纳入主要被送往创伤中心的患者。使用的统计检验包括卡方检验、Kruskal - Wallis检验、Wilcoxon秩和检验和Spearman秩相关检验。
741例被分诊至奥胡斯创伤中心的患者中，我们获取了596例患者的所有信息，构成研究组。472例患者现场有麻醉医生。现场停留时间的中位数及95%置信区间如下：整个研究组（n = 596）15.5分钟（15 - 17）；仅救护车：14.0分钟（12 - 15）；有麻醉医生在场、未插管、未被困：15.0分钟（14 - 16）；插管、未被困：21.5分钟（16 - 27）；被困、未插管：21.5分钟（17 - 25）；插管且被困：22.0分钟（16 - 36）。
麻醉医生的存在使现场停留时间中位数延长了1分钟，院前插管情况下延长了7.5分钟。这一结果与被困导致的延长无差异。
