Ball Chad G, Sutherland Francis R, Dixon Elijah, Feliciano David V, Datta Indraneel, Rajani Ravi R, Hannay Scott, Gomes Anthony, Kirkpatrick Andrew W
Department of Surgery, Grady Memorial Hospital, Atlanta, Georgia, USA.
J Trauma. 2009 Jul;67(1):180-4. doi: 10.1097/TA.0b013e3181a595c3.
Rural citizens die more frequently because of trauma than their urban counterparts. Skill maintenance is a potential issue among rural surgeons because of infrequent exposure to severely injured patients. The primary goal was to evaluate the outcomes of multiple injuries patients who required a laparotomy after referral from level III trauma centers.
All severely injured patients (injury severity score >12) referred to a level I trauma center from level III hospitals, during a 48-month period were evaluated. Comparisons between referrals (level III and IV) as well as survivors and nonsurvivors used standard statistical methodology.
One thousand two hundred and thirty patients (35%) were transferred from level III (33%) and level IV (67%) centers (43% underwent an operative procedure). Only 13% required a laparotomy, whereas 87% needed procedures from other subspecialists. Referred patients had a mean injury severity score of 28, length of stay of 28 days, and mortality rate of 26%. More patients arrived hemodynamically unstable from level IV (55%) versus level III (35%) hospitals (p < 0.05). Nonsurvivors from level III centers were more likely to transfer via aircraft (100%) than from level IV hospitals (55%) (p < 0.05). Most (91%) definitive general surgery procedures could have been completed by surgeons at level III centers; however, 90% also had multisystem injuries requiring treatment by other subspecialists.
Most severely injured patient referrals from level III and IV trauma centers in Western Canada are appropriate. The lack of consistent subspecialty coverage mandates most transfers from level III hospitals. This data will be used to engage rural Alberta physicians in an educational outreach program.
农村居民因创伤死亡的频率高于城市居民。由于很少接触重伤患者，农村外科医生的技能维持是一个潜在问题。主要目标是评估从三级创伤中心转诊后需要剖腹手术的多发伤患者的治疗结果。
对在48个月期间从三级医院转诊至一级创伤中心的所有重伤患者（损伤严重度评分>12）进行评估。使用标准统计方法对转诊医院（三级和四级）以及幸存者和非幸存者进行比较。
1230名患者（35%）从三级（33%）和四级（67%）中心转诊而来（43%接受了手术）。仅13%的患者需要剖腹手术，而87%的患者需要其他专科医生进行手术。转诊患者的平均损伤严重度评分为28分，住院时间为28天，死亡率为26%。与三级医院（35%）相比，从四级医院转诊来的血流动力学不稳定患者更多（55%）（p<0.05）。三级中心的非幸存者通过飞机转诊的可能性（100%）高于四级医院（55%）（p<0.05）。大多数（91%）确定性普外科手术本可由三级中心的外科医生完成；然而，90%的患者也有多系统损伤，需要其他专科医生进行治疗。
加拿大西部三级和四级创伤中心转诊的大多数重伤患者是合适的。由于缺乏持续的专科覆盖，大多数患者从三级医院转诊。这些数据将用于让阿尔伯塔省农村地区的医生参与一个教育推广项目。
