Mell Matthew W, Schneider Peter A, Starnes Benjamin W
Division of Vascular Surgery, Stanford University, Stanford, Calif.
Division of Vascular Therapy, Hawaii Permanente Medical Group and Kaiser Foundation Hospital, Honolulu, Hawaii.
J Vasc Surg. 2015 Aug;62(2):326-30. doi: 10.1016/j.jvs.2015.03.032. Epub 2015 May 1.
No standards exist for interhospital transfer of patients with ruptured abdominal aortic aneurysm (rAAA). As such, many facilities have developed individual approaches to transfer of these patients. The purpose of this study was to investigate areas of agreement and discord for transfer and to determine if current practices may serve as a starting point for developing universal transfer guidelines.
A survey was prepared regarding requirements for transfer, factors regarding transport, and available resources at the accepting hospital. The survey was then offered to members of the Western Vascular Society. Responses were analyzed by physician practice type. Consensus was defined as at least 70% agreement for a response.
Response rate was 40%. The cohort comprised 51% from academic institutions and 94% from metropolitan areas. Patients with rAAA were accepted in transfer by 88% of respondents; a majority accepted transfers from distances of up to 100 miles or more. Most had no formal protocol for transfer or treatment of patients with rAAA. Wide variation was observed regarding local evaluation, clinical status at presentation, pre-existing medical comorbidity and required tests for determining suitability for transfer, and management during transport. Academic physicians were more likely to accept clinically unstable patients and to have capability to offer endovascular aneurysm repair.
Wide variation was observed regarding clinical suitability for transfer, diagnostic criteria and tests before transfer, and essential resources required at the receiving hospital. Reducing existing variation and inefficiencies in the transfer process by developing standard guidelines may improve population-based outcomes for rAAA.
对于腹主动脉瘤破裂（rAAA）患者的院际转运，目前尚无标准。因此，许多机构针对这些患者的转运制定了各自的方法。本研究的目的是调查转运方面的共识和分歧领域，并确定当前的做法是否可作为制定通用转运指南的起点。
准备了一份关于转运要求、转运相关因素以及接收医院可用资源的调查问卷。然后将该问卷提供给西部血管外科学会的成员。根据医生的执业类型对回复进行分析。共识定义为至少70%的回复达成一致。
回复率为40%。该队列中51%来自学术机构，94%来自大都市地区。88%的受访者接受rAAA患者的转运；大多数接受距离达100英里或更远的转运。大多数机构对于rAAA患者的转运或治疗没有正式方案。在当地评估、就诊时的临床状况、既往合并症以及确定转运适宜性所需的检查和转运期间的管理方面，观察到广泛的差异。学术医生更有可能接受临床不稳定的患者，并且有能力提供血管内动脉瘤修复。
在转运的临床适宜性、转运前的诊断标准和检查以及接收医院所需的基本资源方面，观察到广泛的差异。通过制定标准指南来减少转运过程中现有的差异和低效率，可能会改善rAAA患者基于人群的治疗结局。
