Department of Anaesthesia, Centre of Head and Orthopaedics, 4231, Copenhagen University Hospital Rigshospitalet, Copenhagen DK-2100, Denmark.
Emerg Med J. 2011 Sep;28(9):797-801. doi: 10.1136/emj.2010.097535. Epub 2010 Oct 9.
Controversies exist as to whether one should rely on the 'scoop and run' or 'stay and play' approach in the case of penetrating trauma in the prehospital setting. Optimal prehospital care is much debated and the extent to which advanced life support (ALS) measures should be performed remains unclear. This study aimed to report the outcome of penetrating torso trauma in relation to the on-scene time and ALS procedures performed prehospitally. It was hypothesised that a longer on-scene time could predict a higher mortality after penetrating torso trauma.
This was an observational cohort study of penetrating trauma patients treated by the Mobile Emergency Care Unit in Copenhagen with a 30-day follow-up. Between January 2002 and September 2009, data were prospectively registered regarding the anatomical location of the trauma, time intervals and procedures performed in the prehospital setting. Follow-up data were obtained from a national administrative database. The primary end point was 30-day survival.
Of the 467 patients registered, 442 (94.6%) were identified at the 30-day follow-up, of whom 40 (9%) were dead. A higher mortality was found among patients treated on-scene for more than 20 min (p=0.0001), although on-scene time was not a significant predictor of 30-day mortality in the multivariate analysis; OR 3.71, 95% CI 0.66 to 20.70 (p=0.14). The number of procedures was significantly correlated to a higher mortality in the multivariate analysis.
On-scene time might be important in penetrating trauma, and ALS procedures should not delay transport to definite care at the hospital.
在院前环境中，对于穿透性创伤，究竟应该采用“ scooping and run ”还是“ stay and play ”方法存在争议。最佳的院前护理存在很大争议，高级生命支持（ALS）措施应实施到何种程度尚不清楚。本研究旨在报告与现场时间和院前实施的 ALS 程序相关的穿透性躯干创伤的结果。假设现场时间较长可能会预测穿透性躯干创伤后的死亡率更高。
这是一项对哥本哈根移动急救单元治疗的穿透性创伤患者的观察性队列研究，随访时间为 30 天。在 2002 年 1 月至 2009 年 9 月期间，前瞻性地记录了有关创伤解剖位置，现场时间间隔和院前实施的程序的数据。随访数据从国家行政数据库中获得。主要终点是 30 天的生存。
在登记的 467 名患者中，有 442 名（94.6％）在 30 天的随访中得到确认，其中有 40 名（9％）死亡。在现场治疗超过 20 分钟的患者中发现死亡率更高（p=0.0001），尽管在多变量分析中现场时间不是 30 天死亡率的重要预测因素；OR 3.71，95％CI 0.66 至 20.70（p=0.14）。在多变量分析中，操作次数与更高的死亡率显着相关。
现场时间可能在穿透性创伤中很重要，并且 ALS 程序不应延迟转运到医院的确定性治疗。
