外科医生响应时间要求的改变对俄亥俄州三级创伤中心治疗结果的影响：一切都关乎投入。

The effect of a change in the surgeon response time mandate on outcomes within Ohio level III trauma centers: it is all about commitment.

作者信息

Ingraham Angela, Shukla Rakesh, Riebe Jane, Knudson M Margaret, Johannigman Jay

机构信息

Department of Surgery, University of Cincinnati, Cincinnati, Ohio 45267-0558, USA.

出版信息

J Trauma. 2010 May;68(5):1038-43. doi: 10.1097/TA.0b013e3181d486e9.

DOI:10.1097/TA.0b013e3181d486e9

PMID:20453758

Abstract

BACKGROUND

The American College of Surgeons Committee on Trauma guidelines for trauma center verification stipulate that the responsible surgeon be present within 15 minutes of the arrival of a critically injured patient. Recently, these guidelines were liberalized, extending the response time to 30 minutes in level III trauma centers. This study evaluated the potential impact of this guideline change on the delivery of care at Ohio's level III trauma centers. We hypothesized that there would be no measurable difference in the emergency department (ED) length of stay (LOS), ED disposition, and facility mortality after enactment of this mandate, which extended the surgeon response time from 15 minutes to 30 minutes at level III trauma centers.

METHODS

Data were collected from the trauma registries of 13 level III trauma centers in Ohio beginning 2 years before and ending 2 years after June 30, 2004, the day the response time was extended to 30 minutes. Statistical analyses were completed comparing the two groups in terms of demographic and clinical characteristics, surgeon response time, ED disposition, ED LOS, and facility mortality.

RESULTS

A total of 1,076 patients were treated during the 4-year period. The type of trauma, age, and Injury Severity Score were similar between the two groups. The mean (+/-SD) surgeon response times before and after the rule change were 14.8 minutes (+/-19.4 minutes) and 15.5 minutes (+/-22.3 minutes), respectively. The two groups also had similar ED LOS (mean = 2.9, median = 2.5 for both groups), rates of transfer to higher level centers (34.4% vs. 32.8%; p = 0.58), and facility mortality rates (10.0% vs. 11.2%; p = 0.55).

CONCLUSION

The extension of the surgeon response time from 15 minutes to 30 minutes did not adversely affect the outcomes of trauma patients at Ohio's level III trauma centers. Furthermore, the surgeon response time was similar before and after the rule change.

摘要

背景

美国外科医师学会创伤委员会关于创伤中心认证的指南规定，在重伤患者到达后的15分钟内，责任外科医生应到场。最近，这些指南有所放宽，将三级创伤中心的响应时间延长至30分钟。本研究评估了这一指南变化对俄亥俄州三级创伤中心医疗服务提供的潜在影响。我们假设，在该规定颁布后，即三级创伤中心外科医生响应时间从15分钟延长至30分钟后，急诊科住院时间（LOS）、急诊科处置情况和机构死亡率不会有可测量的差异。

方法

从俄亥俄州13家三级创伤中心的创伤登记处收集数据，时间从响应时间延长至30分钟的2004年6月30日之前2年开始，到之后2年结束。完成统计分析，比较两组在人口统计学和临床特征、外科医生响应时间、急诊科处置情况、急诊科住院时间和机构死亡率方面的差异。

结果

在这4年期间共治疗了1076例患者。两组之间的创伤类型、年龄和损伤严重程度评分相似。规则改变前后外科医生的平均（±标准差）响应时间分别为14.8分钟（±19.4分钟）和15.5分钟（±22.3分钟）。两组的急诊科住院时间也相似（两组均值均为2.9，中位数均为2.5），转至更高级别中心的比例（34.4%对32.8%；p = 0.58）以及机构死亡率（10.0%对11.2%；p = 0.55）。