Mauritz Walter, Brazinova Alexandra, Majdan Marek, Rehorcikova Veronika, Leitgeb Johannes
Department of Anesthesia and Intensive Care Medicine, Trauma Hospital "Lorenz Boehler", Donaueschingenstrasse 13, 1200, Vienna, Austria,
Wien Klin Wochenschr. 2014 May;126(9-10):278-85. doi: 10.1007/s00508-014-0521-9. Epub 2014 Mar 21.
The goal of this study was to compare outcomes of patients with severe traumatic brain injury (TBI) who had been admitted either during workdays from 7 a.m. to 7 p.m. ("regular service") or during any other time ("on-call service").
Between March 2002 and April 2012, 17 Austrian centers enrolled TBI patients into two observational studies that focused on effects of guideline compliance (n = 400) and on prehospital and early hospital management (n = 777), respectively. Data on trauma severity, clinical status, treatment, and outcomes were collected prospectively. All patients with severe TBI (Glasgow Coma Scale score < 9) were selected for this analysis. Secondary transfers and patients with unsurvivable injuries were excluded. The International Mission for Prognosis and Analysis of Clinical Trials in TBI core model was used to estimate probabilities of hospital death and unfavorable long-term outcome (Glasgow Outcome Scale score < 4). Based on time of arrival, patients were assigned to groups "regular service" or "on-call service."
Data from 852 patients were analyzed (413 "regular," 439 "on-call service"). "On-call" patients were younger (45 vs. 51 years, P < 0.001) and had a higher rate of alcohol intoxication (41 vs. 11 %, P < 0.001). Trauma severity was comparable; the probabilities of death and unfavorable outcome were identical. There were no differences regarding computed tomography findings or treatment. Hospital mortality (24 vs. 28 %, P = 0.191) and rate of patients with unfavorable outcome at 6 months (43 vs. 48 %, P = 0.143) were comparable.
In Austria, the time of hospital admission has no influence on outcomes after severe TBI.
本研究的目的是比较重度创伤性脑损伤（TBI）患者在工作日上午7点至晚上7点（“常规服务”）或其他任何时间（“随叫随到服务”）入院后的结局。
2002年3月至2012年4月期间，17个奥地利中心将TBI患者纳入两项观察性研究，分别侧重于指南依从性的影响（n = 400）以及院前和早期医院管理（n = 777）。前瞻性收集创伤严重程度、临床状态、治疗和结局的数据。所有重度TBI患者（格拉斯哥昏迷量表评分<9）均纳入本分析。排除二次转运患者和伤势无法存活的患者。采用国际TBI临床试验预后与分析任务核心模型来估计医院死亡概率和不良长期结局（格拉斯哥结局量表评分<4）。根据到达时间，将患者分为“常规服务”组或“随叫随到服务”组。
分析了852例患者的数据（413例“常规”，439例“随叫随到服务”）。“随叫随到”的患者更年轻（45岁对51岁，P < 0.001），酒精中毒率更高（4l%对11%，P < 0.001）。创伤严重程度相当；死亡和不良结局的概率相同。计算机断层扫描结果或治疗方面无差异。医院死亡率（24%对28%，P = 0.191）和6个月时不良结局患者的比例（43%对48%，P = 0.143）相当。
在奥地利，医院入院时间对重度TBI后的结局没有影响。
