Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
Injury. 2010 Sep;41(9):901-6. doi: 10.1016/j.injury.2010.01.002. Epub 2010 Jan 25.
In Germany, physician-operated emergency medical services (EMS) manage most pre-hospital trauma care. Australia uses a different EMS system, deploying highly trained paramedics for road and air transport of trauma patients. The effect of these different systems on secondary insults to traumatic brain injury (TBI) patients is unclear. There is conflicting evidence regarding which system is preferable. To add to the body of evidence, we compared the profile of injury, pre-hospital management and outcomes of TBI patients from both populations.
Cases aged > or = 16 years, with AIS head > or = 3, AIS other body parts < or = 3, recorded in the Victorian State Trauma Registry (VSTR) and Trauma Registry of the German Society of Trauma Surgery (TR-DGU) from 2002 to 2007 were compared.
10,183 cases (5665 German, 4518 Australian) were included. No difference in sex or median age was observed. There were major between-registry differences in type of injury, trauma circumstance, intent and severity of injury. German cases sustained more serious injury and received more pre-hospital interventions. Mortality was significantly higher amongst German patients even when adjusted for demographics, injury severity and in- and pre-hospital parameters. German patients had a longer hospital and ICU stay.
There were clear differences in injury characteristics and outcomes in TBI patients between Germany and Australia. As differences in coding, data collection and patient selection are evident, firm conclusions regarding the contribution of variations in pre-hospital care are not possible. The differences in outcome deserve further exploration in prospective studies.
在德国，由医生运营的紧急医疗服务（EMS）管理大多数院外创伤救治。澳大利亚采用不同的 EMS 系统，部署经过高度培训的护理人员进行创伤患者的道路和空中转运。这些不同系统对创伤性脑损伤（TBI）患者继发性损伤的影响尚不清楚。关于哪种系统更可取，存在相互矛盾的证据。为了增加证据，我们比较了来自这两个群体的 TBI 患者的损伤情况、院前管理和结局。
在 2002 年至 2007 年期间，比较了维多利亚州创伤登记处（VSTR）和德国创伤外科学会创伤登记处（TR-DGU）记录的年龄> = 16 岁、AIS 头部> = 3、AIS 其他身体部位< = 3 的病例。
共纳入 10183 例（德国 5665 例，澳大利亚 4518 例）。未观察到性别或中位年龄的差异。在损伤类型、创伤情况、意图和损伤严重程度方面存在主要的登记处之间的差异。德国患者的损伤更严重，接受了更多的院前干预。即使在调整了人口统计学、损伤严重程度以及入院和院前参数后，德国患者的死亡率仍然显著更高。德国患者的住院和 ICU 停留时间更长。
在 TBI 患者的损伤特征和结局方面，德国和澳大利亚之间存在明显差异。由于编码、数据收集和患者选择方面存在差异，因此无法对院前护理差异的贡献做出明确结论。结果的差异值得在前瞻性研究中进一步探讨。
