College of Nursing, Sungshin Women's University, Seoul, Korea.
J Clin Nurs. 2010 Oct;19(19-20):2763-70. doi: 10.1111/j.1365-2702.2009.03024.x.
To investigate factors influencing time from patient's arrival at the emergency department to surgery in patients with head injury.
A better understanding of factors influencing variation in time from patient's arrival at the emergency department to surgery for patients with head trauma could reduce mortality and morbidity associated with injury.
A cross-sectional study of secondary data.
The sample represented 493 patients with head injury requiring surgery from the 17 level I and II trauma centres. Data were extracted from the National Trauma Data Bank version 4.0. Two-level hierarchical models were used to analyse data at the patient level while incorporating a unique random effect for each trauma centre. Factors entered in the models included patient characteristics and trauma centre characteristics.
Patients with a Glasgow coma scale score of 3-8 in the first ED assessment had earlier time to surgery compared with those with a Glasgow coma scale of 13-15 (β = -0·31, 95% CI = -0·43-0·18). Patients who arrived at the hospital during the nighttime (6pm-8am) had a significantly delayed time to surgery than those who arrived during the daytime (8am-6pm) (β = -0·15, 95% CI = -0·26 to -0·04).
The more severely the injured patients were the faster surgery was performed. The time, when patients arrived to the emergency department was found to be a significant factor influencing time to surgery. Patients who arrived at emergency department at night had longer time to surgery than those who arrived during daytime, despite they were more severely head injured than those who arrived during the day.
When surgical intervention in head-injured patients is anticipated, especially during the night shift, time from patient's arrival at emergency department to surgery should be consistently assessed to identify opportunities for improvement in the structure and process of trauma care.
探讨影响颅脑损伤患者从急诊科到手术时间的因素。
更好地了解影响颅脑创伤患者从急诊科到手术时间变化的因素，可以降低与损伤相关的死亡率和发病率。
一项二次数据的横断面研究。
该样本代表了来自 17 个 I 级和 II 级创伤中心的 493 名需要手术的颅脑损伤患者。数据从国家创伤数据库版本 4.0 中提取。使用两水平层次模型在患者水平上分析数据，同时为每个创伤中心纳入一个独特的随机效应。纳入模型的因素包括患者特征和创伤中心特征。
在急诊科首次评估中格拉斯哥昏迷评分（GCS）为 3-8 的患者手术时间早于 GCS 为 13-15 的患者（β=-0.31，95%CI=-0.43-0.18）。夜间（6 点至 8 点）到达医院的患者手术时间明显延迟，比白天（8 点至 6 点）到达的患者（β=-0.15，95%CI=-0.26 至-0.04）。
受伤越严重的患者手术越快。患者到达急诊科的时间是影响手术时间的一个重要因素。尽管夜间到达急诊科的患者比白天到达的患者颅脑损伤更严重，但他们的手术时间却更长。
当预计对颅脑损伤患者进行手术干预时，尤其是在夜间轮班时，应持续评估从患者到达急诊科到手术的时间，以确定在创伤护理的结构和流程方面改进的机会。
