Department of Surgery, Monklands Hospital, Airdrie, UK.
Surgeon. 2013 Oct;11(5):272-7. doi: 10.1016/j.surge.2013.01.003. Epub 2013 Feb 9.
Haemorrhage is a leading cause of death from trauma. Management requires a combination of haemorrhage control and resuscitation which may incur significant surgical and transfusion utilisation. The aim of this study is to evaluate the resource provision of the destination hospital of Scottish trauma patients exhibiting evidence of pre-hospital shock.
Patients who sustained a traumatic injury between November 2008 and October 2010 were retrospectively identified from the Scottish Ambulance Service electronic patients record system. Patients with a systolic blood pressure less than 110 mmHg or if missing, a heart rate greater than 120 bpm, were considered in shock. The level of the destination healthcare facility was classified in terms of surgical and transfusion capability. Patients with and without shock were compared.
There were 135,004 patients identified, 133,651 (99.0%) of whom had sustained blunt trauma, 68,411 (50.7%) were male and the median (IQR) age was 59 (46). There were 6721 (5.0%) patients with shock, with a similar age and gender distribution to non-shocked patients. Only 1332 (19.8%) of shocked patients were taken to facilities with full surgical capability, 5137 (76.4%) to hospitals with limited (general and orthopaedic surgery only) and 252 (3.7%) to hospitals with no surgical services. In terms of transfusion capability, 5556 (82.7%) shocked patients were admitted to facilities with full capability and 1165 (17.3%) to a hospital with minimal or no capability.
The majority of Scottish trauma patients are transported to a hospital with full transfusion capability, although the majority lack surgical sub-specialty representation.
出血是创伤导致死亡的主要原因。其治疗需要结合出血控制和复苏，这可能会大量应用外科和输血。本研究旨在评估苏格兰创伤患者出现院前休克迹象时的目标医院的资源配置情况。
从苏格兰救护服务电子患者记录系统中回顾性地确定了 2008 年 11 月至 2010 年 10 月间发生创伤的患者。收缩压＜110mmHg 或心率＞120bpm 的患者被认为存在休克。根据外科和输血能力将目标医疗设施的级别进行分类。比较了有休克和无休克的患者。
共确定了 135004 名患者，其中 133651 名（99.0%）为钝器伤，68411 名（50.7%）为男性，中位（IQR）年龄为 59（46）岁。有 6721 名（5.0%）患者有休克，其年龄和性别分布与无休克患者相似。仅有 1332 名（19.8%）休克患者被送往具有完全外科能力的医疗机构，5137 名（76.4%）被送往仅有一般和骨科手术能力的医院，252 名（3.7%）被送往没有外科服务的医院。在输血能力方面，5556 名（82.7%）休克患者被送往有完全能力的医疗机构，1165 名（17.3%）被送往能力有限或无能力的医院。
尽管大多数外科亚专业都缺乏，但大多数苏格兰创伤患者都被送往具有完全输血能力的医院。
