我们是否为骨盆创伤提供了两种标准的护理？在非工作时间和周末提供血管栓塞术会增加治疗干预的时间。
Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention.
机构信息
From the Departments of Surgery (D.A.S., M.M., B.A.C., E.R., C.E.W., J.B.H.), Diagnostic and Interventional Radiology (A.M.C.), and Orthopedic Surgery (A.R.B.), and the Center for Translational Injury Research (B.A.C., C.E.W., A.M.B., J.B.H.), The University of Texas Health Science Center, Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2014 Jan;76(1):134-9. doi: 10.1097/TA.0b013e3182ab0cfc.
BACKGROUND
We hypothesized that patients with pelvic fractures and hemorrhage admitted during daytime hours were undergoing interventional radiology (IR) earlier than those admitted at night and on weekends, thereby establishing two standards of time to hemorrhage control.
METHODS
The trauma registry (January 2008 to December 2011) was reviewed for patients admitted with pelvic fractures, hemorrhagic shock, and transfusion of at least 1 U of blood. The control group (DAY) was admitted from 7:30 AM to 5:30 PM Monday to Friday, while the study group (after hours [AHR]) was admitted from 5:30 PM to 7:30 AM, on weekends or holidays.
RESULTS
A total of 191 patients met the criteria (45 DAY, 146 AHR); 103 died less than 24 hours and without undergoing IR (29% DAY group vs. 62% AHR, p < 0.001). Sixteen patients (all in AHR group) died while awaiting IR (p = 0.032). Eighty-eight patients (32 DAY, 56 AHR) survived to receive IR. Among these, the AHR group were younger (median, 30 years vs. 54 years; p = 0.007), more tachycardic (median pulse, 119 beats/min vs. 90 beats/min; p = 0.001), and had more profound shock (median base, -10 vs. -6; p = 0.006) on arrival. Time from admission to IR (median, 301 minutes vs. 193 minutes; p < 0.001) and computed tomographic scan to IR (176 minutes vs. 87 minutes, p = 0.011) were longer in the AHR group. There was no difference in the 30-day mortality by univariate analysis. However, after controlling for age, arrival physiology, injury severity, and degree of shock, the AHR group had a 94% increased risk of mortality.
CONCLUSION
The current study demonstrated that patients admitted at night and on weekends have a significant increase in time to angioembolization compared with those arriving during the daytime and during the week. Multivariate regression noted that AHR management was associated with an almost 100% increase in mortality. While this is a single-center study and retrospective in nature, it suggests that we are currently delivering two standards of care for pelvic trauma, depending on the day and time of admission.
LEVEL OF EVIDENCE
Therapeutic study, level II.
背景
我们假设白天时段入院的骨盆骨折伴出血患者比夜间和周末时段入院的患者更早接受介入放射学（IR）治疗，从而建立了两种控制出血的时间标准。
方法
回顾性分析 2008 年 1 月至 2011 年 12 月期间因骨盆骨折、出血性休克和至少输注 1 单位血液入院的患者的创伤登记处。对照组（白天）是指周一至周五上午 7:30 至下午 5:30 入院，而研究组（夜间/周末）是指下午 5:30 至次日上午 7:30 入院，包括周末和节假日。
结果
共有 191 名患者符合标准（45 名白天组，146 名夜间/周末组）；103 名患者在 24 小时内死亡且未接受 IR（白天组 29%，夜间/周末组 62%，p<0.001）。16 名患者（均在夜间/周末组）在等待 IR 治疗时死亡（p=0.032）。88 名患者（白天组 32 名，夜间/周末组 56 名）存活并接受了 IR 治疗。其中，夜间/周末组的患者年龄更小（中位数，30 岁 vs. 54 岁；p=0.007），心率更快（中位数脉搏，119 次/分钟 vs. 90 次/分钟；p=0.001），休克程度更深（中位数基础值，-10 比-6；p=0.006）。夜间/周末组从入院到接受 IR 的时间（中位数，301 分钟 vs. 193 分钟；p<0.001）和从 CT 扫描到接受 IR 的时间（176 分钟 vs. 87 分钟，p=0.011）均更长。单因素分析显示，两组患者 30 天死亡率无差异。然而，在校正年龄、入院时生理状况、损伤严重程度和休克程度后，夜间/周末组的死亡率增加了 94%。
结论
本研究表明，与白天和工作日入院的患者相比，夜间和周末入院的患者接受血管栓塞治疗的时间显著延长。多变量回归分析表明，夜间/周末管理与近 100%的死亡率增加相关。虽然这是一项单中心研究且为回顾性研究，但它表明我们目前根据入院时间提供两种骨盆创伤护理标准。
证据等级
治疗研究，II 级。
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