多发伤钝性伤患者院内转送至 1 级创伤中心不会对预后产生不良影响。
Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome.
机构信息
Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
Department of Diagnostic Radiology, University of Louisville School of Medicine, Louisville, KY, USA.
出版信息
Am J Surg. 2014 Apr;207(4):459-66. doi: 10.1016/j.amjsurg.2013.04.015.
BACKGROUND
Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs).
METHODS
We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center.
RESULTS
Referred patients were older, more often women, and had more severe TBI (all P < .05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer.
CONCLUSIONS
Interhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.
背景
对于重伤患者，在非创伤中心停留被认为会增加死亡率和成本，这可能是由于不必要的影像学检查以及对创伤性脑损伤（TBI）的犹豫不决/延迟治疗。
方法
我们研究了 754 例连续的钝器伤患者，损伤严重程度评分（ISS）大于 20，其中 212 例患者在到达我们的 1 级创伤中心的途中在其他地方接受了治疗。
结果
转院患者年龄更大，女性更多，TBI 更严重（均 P<.05）。在对年龄、性别和损伤模式进行校正后，转院和直接收治患者的 TBI 类型、到达创伤中心时的格拉斯哥昏迷评分（GCS）以及总体死亡率均无差异。外部机构的 GCS 并未影响转院的及时性。
结论
医院间的转院并不会影响钝器伤患者的预后。然而，对于那些在缺乏神经外科护理的医院中 GCS 较低的患者，不必要地延长住院时间是不合适的。
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