Department of Surgery, University of Washington, Seattle, Washington 98005, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):567-73; discussion 573-5; quiz 803. doi: 10.1097/TA.0b013e31824baddf.
There is ongoing controversy about the relative effectiveness of air medical versus ground transportation for severely injured patients. In some systems, air medical crews may provide a higher level of care but may require longer transport times. We sought to evaluate the impact of mode of transport on outcome based on analysis of data from two randomized trials of prehospital hypertonic resuscitation.
Injured patients were enrolled based on prehospital evidence of hypovolemic shock (systolic blood pressure ≤70 mm Hg or systolic blood pressure = 71-90 mm Hg with heart rate ≥108 bpm) or severe traumatic brain injury (TBI; Glasgow Coma Scale score ≤8). Patient demographics, injury severity, and physiology were compared based on mode of transport. Multivariate logistic regression was used to determine the impact of mode of transport on 24-hour and 28-day survival for all patients and 6-month extended Glasgow Outcome Scale for patients with TBI, adjusting for differences in injury severity.
Included were 2,049 patients, of which 703 (34%) were transported by air. Patients transported by air were more severely injured (mean Injury Severity Score, 30.3 vs. 22.8; p < 0.001), more likely to be in the TBI cohort (70% vs. 55.4%; p < 0.001), and more likely blunt mechanism (94.0% vs. 78.1%; p < 0.001). Patients transported by air had higher rates of prehospital intubation (81% vs. 36%; p < 0.001), received more intravenous fluids (mean 1.3 L vs. 0.8 L; p < 0.001), and had longer prehospital times (mean 76.1 minutes vs. 43.5 minutes; p < 0.001). Adjusted analysis revealed no significant impact of mode of transport on survival or 6-month neurologic outcome (air transport-28-day survival: odds ratio, 1.11; 95% confidence interval, 0.82-1.51; 6-month extended Glasgow Outcome Scale score ≤4: odds ratio, 0.94; 95% confidence interval, 0.68-1.31).
There was no difference in the adjusted clinical outcome according to mode of transport. However, air medical transported more severely injured patients with more advanced life support procedures and longer prehospital time.
III.
关于严重受伤患者使用空中医疗与地面运输的相对效果仍存在争议。在某些系统中，空中医疗人员可能提供更高水平的护理，但可能需要更长的运输时间。我们试图根据两项院前高渗复苏随机试验的数据来评估运输方式对结果的影响。
根据院前低血容量性休克（收缩压≤70mmHg 或收缩压=71-90mmHg，心率≥108 次/分）或严重创伤性脑损伤（TBI；格拉斯哥昏迷量表评分≤8）的证据，入组受伤患者。根据运输方式比较患者的人口统计学、损伤严重程度和生理学特征。多变量逻辑回归用于确定所有患者 24 小时和 28 天生存率以及 TBI 患者 6 个月扩展格拉斯哥结局量表的运输方式的影响，调整损伤严重程度的差异。
共纳入 2049 例患者，其中 703 例（34%）通过空运运输。通过空运运输的患者损伤更严重（平均损伤严重程度评分，30.3 对 22.8；p＜0.001），更有可能属于 TBI 队列（70%对 55.4%；p＜0.001），更有可能为钝性机制（94.0%对 78.1%；p＜0.001）。空运患者的院前插管率更高（81%对 36%；p＜0.001），接受的静脉输液量更多（平均 1.3L 对 0.8L；p＜0.001），院前时间更长（平均 76.1 分钟对 43.5 分钟；p＜0.001）。调整分析显示，运输方式对生存率或 6 个月神经结局无显著影响（空运 28 天生存率：比值比，1.11；95%置信区间，0.82-1.51；6 个月扩展格拉斯哥结局量表评分≤4：比值比，0.94；95%置信区间，0.68-1.31）。
根据运输方式，调整后的临床结局无差异。然而，空中医疗转运了更多严重损伤、具有更先进生命支持程序和更长院前时间的患者。
III。
