Rainer Timothy H, Cheung N K, Yeung Janice H H, Graham Colin A
Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Trauma & Emergency Centre, Prince of Wales Hospital, Shatin NT, Hong Kong, SAR, China.
Resuscitation. 2007 Jun;73(3):374-81. doi: 10.1016/j.resuscitation.2006.10.011. Epub 2007 Feb 7.
To evaluate the association between trauma team activation according to well-established protocols and patient survival.
Single centre, registry study of data collected prospectively from trauma patients (who were treated in a trauma resuscitation room, who died or who were admitted to ICU) of a tertiary referral trauma centre Emergency Department (ED) in Hong Kong. A 10-point protocol was used to activate rapid trauma team response to the ED. The main outcome measures were mortality, need for ICU care, or operation within 6h of injury.
Between 1 January 2001 and 31 December 2005, 2539 consecutive trauma patients were included in our trauma registry, of which 674 patients (mean age 43 years, S.D. 22; 71% male; 94% blunt trauma) met trauma call criteria. Four hundred and eighty two (72%) correctly triggered a trauma call, and 192 (28%) were not called ('undercall'). Patients were less likely to have a trauma call despite meeting criteria if they were aged over 64 years, had sustained a fall, had a respiratory rate <10 or >29 per minute, a systolic blood pressure between 60 and 89 mm Hg, or a GCS of 9-13. In a sub-group of moderately poor probability of survival (probability of survival, P(s), 0.5-0.75), the odds ratio for mortality in the undercall group compared with the trauma call group was 7.6 (95% CI, 1.1-33.0).
In our institution, undercalls account for 28% of patients who meet trauma call criteria and in patients with moderately poor probability of survival undercall is associated with decreased survival. Although trauma team activation does not guarantee better survival, better compliance with trauma team activation protocols optimises processes of care and may translate into improved survival.
评估依据既定方案启动创伤团队与患者生存之间的关联。
对香港一家三级转诊创伤中心急诊科前瞻性收集的创伤患者（在创伤复苏室接受治疗、死亡或入住重症监护病房的患者）数据进行单中心登记研究。采用一个10分制方案来启动对急诊科的快速创伤团队反应。主要结局指标为死亡率、伤后6小时内入住重症监护病房的需求或手术需求。
在2001年1月1日至2005年12月31日期间，2539例连续的创伤患者被纳入我们的创伤登记，其中674例患者（平均年龄43岁，标准差22；71%为男性；94%为钝性创伤）符合创伤呼叫标准。482例（72%）正确触发了创伤呼叫，192例（28%）未被呼叫（“漏呼”）。如果患者年龄超过64岁、有跌倒史、呼吸频率每分钟<10次或>29次、收缩压在60至89毫米汞柱之间或格拉斯哥昏迷评分在9 - 13分，则尽管符合标准但被呼叫的可能性较小。在生存概率中等偏低（生存概率，P(s)，0.5 - 0.75）的亚组中，漏呼组与创伤呼叫组相比的死亡比值比为7.6（95%置信区间，1.1 - 33.0）。
在我们机构，漏呼占符合创伤呼叫标准患者的28%，且在生存概率中等偏低的患者中，漏呼与生存率降低相关。尽管启动创伤团队并不能保证更好的生存，但更好地遵守创伤团队启动方案可优化护理流程并可能转化为生存率的提高。
