Regional Trauma Services, Foothills Medical Centre, University of Calgary, 29 Street, Calgary, NW 1403, Alberta.
World J Emerg Surg. 2013 Nov 18;8(1):48. doi: 10.1186/1749-7922-8-48.
Traumatic brain injury (TBI) constitutes the leading cause of posttraumatic mortality. Practically, the major interventions required to treat TBI predicate expedited transfer to CT after excluding other immediately life-threatening conditions. At our center, trauma responses variably consist of either full trauma activation (FTA) including an attending trauma surgeon or a non-trauma team response (NTTR). We sought to explore whether FTAs expedited the time to CT head (TTCTH).
Retrospective review of augmented demographics of 88 serious head injuries identified from a Regional Trauma Registry within one year at a level I trauma center. The inclusion criteria consisted of a diagnosis of head injury recorded as intubated or GCS < 13; and CT-head scanning after arriving the emergency department. Data was analyzed using STATA.
There were 58 FTAs and 30 NTTRs; 86% of FTAs and 17% of NTTRs were intubated prehospital out of 101 charts reviewed in detail; 13 were excluded due to missing data. Although FTAs were more seriously injured (median ISS 29, MAIS head 19, GCS score at scene 6.0), NTTRs were also severely injured (median ISS 25, MAIS head 21, GCS at scene 10) and older (median 54 vs. 26 years). Median TTCTH was double without dedicated FTA (median 50 vs. 26 minutes, p < 0.001), despite similar justifiable delays (53% NTTR, 52% FTA). Without FTA, most delays (69%) were for emergency intubation. TTCTH after securing the airway was longer for NTTR group (median 38 vs. 26 minutes, p =0.0013). Even with no requirements for ED interventions, TTCTH for FTA was less than half versus NTTR (25 vs. 61 minutes, p =0.0013). Multivariate regression analysis indicated age and FTA with an attending surgeon as significant predictors of TTCTH, although the majority of variability in TTCTH was not explained by these two variables (R² = 0.33).
Full trauma activations involving attending trauma surgeons were quicker at transferring serious head injury patients to CT. Patients with FTA were younger and more seriously injured. Discerning the reasons for delays to CT should be used to refine protocols aimed at minimizing unnecessary delays and enhancing workforce efficiency and clinical outcome.
创伤性脑损伤（TBI）是创伤后死亡的主要原因。实际上，为了治疗 TBI，需要尽快将患者送往 CT 检查，同时排除其他危及生命的紧急情况。在我们中心，创伤反应要么是完全的创伤激活（FTA），包括主治创伤外科医生，要么是非创伤团队反应（NTTR）。我们试图探讨 FTA 是否能加快头部 CT 检查时间（TTCTH）。
对一年内在一级创伤中心的区域创伤登记处确定的 88 例严重头部损伤的增强人口统计学数据进行回顾性分析。纳入标准包括记录为插管或 GCS<13 的头部损伤诊断；并在到达急诊室后进行头部 CT 扫描。使用 STATA 进行数据分析。
共有 58 例 FTA 和 30 例 NTTR；在详细审查的 101 份图表中，86%的 FTA 和 17%的 NTTR在院前进行了插管；由于数据缺失，有 13 例被排除在外。尽管 FTA 患者的伤势更严重（ISS 中位数 29，MAIS 头部 19，现场 GCS 评分 6.0），但 NTTR 患者的伤势也很严重（ISS 中位数 25，MAIS 头部 21，现场 GCS 评分 10）且年龄更大（中位数 54 岁比 26 岁）。没有专门的 FTA 时，TTCTH 翻倍（中位数 50 分钟比 26 分钟，p<0.001），尽管合理的延迟时间相似（53%的 NTTR，52%的 FTA）。没有 FTA 时，大多数延迟（69%）是为了紧急插管。NTTR 组在气道得到保障后进行 TTCTH 的时间更长（中位数 38 分钟比 26 分钟，p=0.0013）。即使没有 ED 干预的要求，FTA 的 TTCTH 也比 NTTR 短一半（25 分钟比 61 分钟，p=0.0013）。多变量回归分析表明，年龄和有主治外科医生的 FTA 是 TTCTH 的显著预测因素，尽管这两个变量并不能解释 TTCTH 大部分的差异（R²=0.33）。
涉及主治创伤外科医生的完全创伤激活能更快地将严重头部损伤患者送往 CT 检查。FTA 患者年龄较小，伤势更重。应查明 CT 延迟的原因，以完善旨在尽量减少不必要的延迟和提高劳动力效率和临床效果的协议。
