有益之恶更可取：为城市环境中穿透性创伤受害者的基础生命支持转运提供依据。
The evil of good is better: Making the case for basic life support transport for penetrating trauma victims in an urban environment.
作者信息
Rappold Joseph F, Hollenbach Kathryn A, Santora Thomas A, Beadle Dania, Dauer Elizabeth D, Sjoholm Lars O, Pathak Abhijit, Goldberg Amy J
机构信息
From the Department of Surgery (J.F.R., T.A.S., D.B., E.D.D., L.O.S., A.P., A.J.G.), Temple University School of Medicine, Philadelphia, Pennsylvania; UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences (K.A.H.), La Jolla, California.
出版信息
J Trauma Acute Care Surg. 2015 Sep;79(3):343-8. doi: 10.1097/TA.0000000000000783.
BACKGROUND
Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers.
METHODS
A retrospective cohort study was conducted at an urban Level I trauma center. Victims of penetrating trauma transported by ALS, BLS, or police from January 1, 2008, to November 31, 2013, were identified. Patient survival by mode of transport and by level of care received was analyzed using logistic regression.
RESULTS
During the study period, 1,490 penetrating trauma patients were transported by ALS (44.8%), BLS (15.6%), or police (39.6%) personnel. The majority of injuries were gunshot wounds (72.9% for ALS, 66.8% for BLS, 90% for police). Median transport minutes were significantly longer for ALS (16 minutes) than for BLS (14.5 minutes) transports (p = 0.012). After adjusting for transport time and Injury Severity Score (ISS), among victims with an ISS of 0 to 30, there was a 2.4-fold increased odds of death (95% confidence interval [CI], 1.3-4.4) if transported by ALS as compared with BLS. With an ISS of greater than 30, this relationship did not exist (odds ratio, 0.9; 95% CI, 0.3-2.7). When examined by type of care provided, patients with an ISS of 0 to 30 given ALS support were 3.7 times more likely to die than those who received BLS support (95% CI, 2.0-6.8). Among those with an ISS of greater than 30, no relationship was evident (odds ratio, 0.9; 95% CI, 0.3-2.7).
CONCLUSION
Among penetrating trauma victims with an ISS of 30 or lower, an increased odds of death was identified for those treated and/or transported by ALS personnel. For those with an ISS of greater than 30, no survival advantage was identified with ALS transport or care. Results suggest that rapid transport may be more important than increased interventions.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
在城市环境中，对于穿透性创伤患者的理想转运方式仍存在争议。大多数城市中心同时采用高级生命支持（ALS）和基础生命支持（BLS）转运方式。
方法
在一家城市一级创伤中心进行了一项回顾性队列研究。确定了2008年1月1日至2013年11月31日期间由ALS、BLS或警察转运的穿透性创伤患者。使用逻辑回归分析按转运方式和接受的护理水平划分的患者生存率。
结果
在研究期间，1490例穿透性创伤患者由ALS人员（44.8%）、BLS人员（15.6%）或警察（39.6%）转运。大多数损伤为枪伤（ALS组为72.9%，BLS组为66.8%，警察转运组为90%）。ALS转运的中位时间（16分钟）显著长于BLS转运（14.5分钟）（p = 0.012）。在调整转运时间和损伤严重程度评分（ISS）后，在ISS为0至30的受害者中，与BLS转运相比，由ALS转运的患者死亡几率增加了2.4倍（95%置信区间[CI]，1.3 - 4.4）。ISS大于30时，这种关系不存在（比值比，0.9；95% CI，0.3 - 2.7）。按提供的护理类型检查时，ISS为0至30且接受ALS支持的患者死亡可能性是接受BLS支持患者的3.7倍（95% CI，2.0 - 6.8）。在ISS大于30的患者中，没有明显关系（比值比，0.9；95% CI，0.3 - 2.7）。
结论
在ISS为30或更低的穿透性创伤受害者中，由ALS人员治疗和/或转运的患者死亡几率增加。对于ISS大于30的患者，ALS转运或护理未显示出生存优势。结果表明，快速转运可能比增加干预措施更重要。
证据水平
治疗性研究，IV级。
Zotero 插件