Thomas Stephen H, Arthur Annette O, Howard Zoe, Shear Melissa L, Kadzielski John L, Vrahas Mark S
Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK 74104, USA.
Air Med J. 2013 Mar-Apr;32(2):74-9. doi: 10.1016/j.amj.2012.06.007.
This study had 3 major aims: (1) to ascertain the degree to which helicopter emergency medical services (HEMS) administration of antibiotics (Abx) can streamline the time to Abx in open fracture patients, (2) to determine whether any clinical outcome improvements were associated with HEMS Abx therapy, and (3) to calculate the cost-effectiveness of prehospital HEMS Abx. The design of the study was a prospective, nonrandomized, nonintervention, natural study of timing and clinical outcomes for patients with suspected open extremity fracture. There were 138 scene trauma cases transported by 8 participating HEMS programs from July 2009 to June 2010. The participating HEMS programs were both urban and rural. The diagnosis of an open fracture by the HEMS crews had an accuracy rate of 97.8% (95% confidence interval, 90.8%-98.4%). The time from the incident to Abx was 30 minutes shorter (P = .0001) when Abx were administered by HEMS crews. There was no statistical significance (P = 1.0) regarding the endpoint of infection or nonunion development in HEMS- versus hospital-administered Abx. In conclusion, the administration of Abx by HEMS crews to patients diagnosed with open extremity fractures is feasible, it may decrease the time to Abx by 30 minutes, and the effect magnitude (40.3% relative risk reduction) was promising.
本研究有3个主要目标：（1）确定直升机紧急医疗服务（HEMS）给予抗生素（Abx）能在多大程度上缩短开放性骨折患者使用Abx的时间，（2）确定HEMS给予Abx治疗是否与任何临床结局改善相关，（3）计算院前HEMS给予Abx的成本效益。该研究设计为对疑似开放性四肢骨折患者的时间和临床结局进行前瞻性、非随机、非干预的自然研究。2009年7月至2010年6月，8个参与研究的HEMS项目共转运了138例现场创伤病例。参与研究的HEMS项目既有城市的也有农村的。HEMS急救人员对开放性骨折的诊断准确率为97.8%（95%置信区间，90.8%-98.4%）。当由HEMS急救人员给予Abx时，从事件发生到使用Abx的时间缩短了30分钟（P = .0001）。在感染或骨不连发生的终点方面，HEMS给予Abx与医院给予Abx相比无统计学意义（P = 1.0）。总之，HEMS急救人员对诊断为开放性四肢骨折的患者给予Abx是可行的，它可能将使用Abx的时间缩短30分钟，且效果幅度（相对风险降低40.3%）很可观。
