Garwe Tabitha, Cowan Linda D, Neas Barbara R, Sacra John C, Albrecht Roxie M, Rich Katy M
Trauma Division, Oklahoma State Department of Health, Oklahoma City, Oklahoma 73117, USA.
J Trauma. 2011 Jan;70(1):120-9. doi: 10.1097/TA.0b013e3181d89439.
Indications for direct transport may be strongly related to risk of future health outcomes, and these indications may not be adequately controlled by considering only in-hospital variables. This study was designed to identify prehospital factors associated with directness of transport.
The study included 2,062 patients treated at a Level I trauma center between January 1, 2006, and December 31, 2007. The outcome of interest was directness of transport to a Level I trauma center. A propensity score analysis was used to identify demographic, clinical, distance, and other injury scene-related variables associated with the probability of direct transport.
A total of 1,459 patients were directly transported to the Level I trauma center and 603 were transferred from lower level facilities. Patients were more likely to be transported directly if they had lower Glasgow Comma Scale scores, had penetrating injuries, were involved in traffic-related injuries, were closer to a Level IV or I trauma center, and if an advanced life support emergency medical service agency transported them from the scene. Patients were more likely to initially stop if they required advanced airway management, met at least one anatomic criterion, were further away from a Level I trauma center, or closer to an intermediate facility.
Confounding due to unadjusted prehospital factors may be present in studies evaluating the impact of directness of transport on short-term mortality outcomes. Propensity score analysis of treatment indications provides an additional and efficient method to reduce this bias.
直接转运的指征可能与未来健康结局的风险密切相关，而仅考虑院内变量可能无法充分控制这些指征。本研究旨在确定与转运直接性相关的院前因素。
该研究纳入了2006年1月1日至2007年12月31日期间在一级创伤中心接受治疗的2062例患者。感兴趣的结局是直接转运至一级创伤中心。采用倾向评分分析来确定与直接转运概率相关的人口统计学、临床、距离及其他与受伤现场相关的变量。
共有1459例患者直接转运至一级创伤中心，603例从较低级别的医疗机构转诊而来。格拉斯哥昏迷量表评分较低、有穿透伤、涉及交通相关损伤、距离四级或一级创伤中心较近以及由高级生命支持紧急医疗服务机构从现场转运的患者更有可能被直接转运。如果患者需要高级气道管理、符合至少一项解剖学标准、距离一级创伤中心较远或距离中级医疗机构较近，则更有可能最初被送往其他医疗机构。
在评估转运直接性对短期死亡率结局的影响的研究中，可能存在因未调整的院前因素导致的混杂情况。对治疗指征进行倾向评分分析提供了一种额外且有效的方法来减少这种偏倚。
