Greene Wendy, Robinson Linda, Rizzo Anne G, Sakran Joseph, Hendershot Kimberly, Moore Aaron, Weatherspoon Kimberly, Fakhry Samir M
Trauma Services, Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia, USA.
J Trauma. 2007 Sep;63(3):550-4; discussion 554-5. doi: 10.1097/TA.0b013e31809ff244.
Trauma complicates 6% to 7% of all pregnancies. Adverse outcomes are rare when monitoring is normal and early warning signs absent. Trauma systems often use pregnancy as the sole criterion (PSC) for partial trauma team activation. This study compares outcomes of pregnant patients presenting with PSC versus other physiologic, mechanistic, or anatomic (OPMA) activation criteria.
Three hundred fifty-two consecutive obstetric partial trauma team activation patients (2000-2005) were grouped by length of gestation and evaluated for activation criteria and early maternal and fetal outcomes. Data were analyzed using descriptive statistics and analysis of variance.
Patients ranged in age from 16 to 44 (mean age, 28 +/- 6.4) and in weeks gestation between 1 and 40 weeks (mean, 25 +/- 8 weeks). Eighty-two percent had been in vehicle crashes. One hundred eighty-eight (58%) were activated based on PSC and 137 on OPMA. No PSC patient had injuries sufficient to warrant trauma service admission. Ninety-four percent of all PSCs of <20 weeks were discharged home from the emergency department. There were no maternal mortalities. There were four fetal mortalities; two pregnancies were terminally compromised before the trauma event. No patient in the PSC group required admission to the trauma service. There were seven cases of abruption (2%) and 18 cases of vaginal bleeding or discharge (6%). No case of vaginal bleeding or abruption in the first 20 weeks was hypotensive at the scene or on arrival.
In this study, pregnancy was not an independent predictor of the need for trauma team activation. Standard OPMA trauma activation criteria apply equally to pregnant and nonpregnant patients. These data provide support for more judicious allocation of scarce trauma systems resources.
创伤使6%至7%的妊娠出现并发症。当监测正常且无早期预警信号时，不良结局很少见。创伤系统通常将妊娠作为部分创伤团队启动的唯一标准（PSC）。本研究比较了以PSC就诊的孕妇与其他生理、机制或解剖学（OPMA）启动标准的孕妇的结局。
对2000年至2005年连续352例产科部分创伤团队启动患者按孕周分组，并评估启动标准以及孕产妇和胎儿早期结局。使用描述性统计和方差分析对数据进行分析。
患者年龄在16至44岁之间（平均年龄28±6.4岁），孕周在1至40周之间（平均25±8周）。82%的患者遭遇过车祸。188例（58%）基于PSC启动，137例基于OPMA启动。没有PSC患者的损伤严重到需要创伤服务收治。孕周<20周的所有PSC患者中，94%从急诊科出院回家。没有孕产妇死亡。有4例胎儿死亡；2例妊娠在创伤事件前已处于终末期受损状态。PSC组没有患者需要收治到创伤服务。有7例胎盘早剥（2%）和18例阴道出血或分泌物（6%）。前20周内没有阴道出血或胎盘早剥病例在现场或到达时出现低血压。
在本研究中，妊娠不是创伤团队启动需求的独立预测因素。标准的OPMA创伤启动标准同样适用于孕妇和非孕妇。这些数据为更明智地分配稀缺的创伤系统资源提供了支持。
