Wyen Hendrik, Wutzler Sebastian, Rüsseler Miriam, Mack Martin, Walcher Felix, Marzi Ingo
Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
Department of Radiology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
Eur J Trauma Emerg Surg. 2009 Oct;35(5):448. doi: 10.1007/s00068-009-9140-y. Epub 2009 Sep 17.
A regionalized approach to trauma care with the implementation of designated level I trauma centers has been shown to improve survival after multiple injuries. Our study aimed to describe the current reality in an urban German level I university trauma center concerning the primary admission of patients into the emergency room.
We performed a retrospective analysis of all multiple trauma patients that were prospectively documented in our documentation system TraumaWatch(®) from 2003 to 2007. Documentation included physiological findings as well as diagnostic and therapeutic procedures structured as: (A) preclinical phase; (B) emergency room treatment; (C) intensive care unit; and (D) final outcome according to the German Trauma Registry.
In total, 1,848 patients were completely documented and, thus, analyzed. The mean ± standard deviation (SD) Injury Severity Score (ISS) was 16.5 ± 14.1 points and the mean ± SD age was 38.7 ± 21.9 years. An increasing number of patients received whole-body computed tomography (48.8% in 2003 vs. 83.3%in 2007, p < 0.001) and, on average, the ISS increased over the years (14.4 points in 2003 vs. 17.9 points in 2007). The overall hospital mortality was 7.1%, without significant change over time. The completionofimagingdiagnostics became significantly faster for all of the documented procedures (X-ray pelvis, X-ray chest, whole-body CT, abdominal ultrasound) (p < 0.001).
Descriptive data on the current reality in urban level I trauma care can be derived from our study. Additionally, we achieved improved time intervals for emergency diagnostics and treatment, while hospital mortality remained constant, despite a higher injury severity. This is due to a standardized protocol which is applied during the 24-h in-house attending coverage.
Regionalized trauma care with designated level I trauma centers is justified by the improvement of time intervals and outcome, but adequate resources are required.
采用区域化创伤护理方法并设立指定的一级创伤中心已被证明可提高多发伤后的生存率。我们的研究旨在描述德国一所城市一级大学创伤中心在患者初次进入急诊室方面的现状。
我们对2003年至2007年在我们的文档系统TraumaWatch(®)中前瞻性记录的所有多发伤患者进行了回顾性分析。文档记录包括生理检查结果以及按照以下分类的诊断和治疗程序：(A) 临床前期；(B) 急诊室治疗；(C) 重症监护病房；以及 (D) 根据德国创伤登记处记录的最终结果。
总共1848例患者有完整记录并因此进行了分析。平均±标准差 (SD) 的损伤严重度评分 (ISS) 为16.5±14.1分，平均±SD年龄为38.7±21.9岁。接受全身计算机断层扫描的患者数量不断增加（2003年为48.8%，2007年为83.3%，p<0.001），并且平均而言，ISS多年来有所增加（2003年为14.4分，2007年为17.9分）。总体医院死亡率为7.1%，随时间无显著变化。所有记录的程序（骨盆X线、胸部X线、全身CT、腹部超声）的影像学诊断完成时间显著加快（p<0.001）。
我们的研究可以得出关于城市一级创伤护理现状的描述性数据。此外，尽管损伤严重度更高，但我们缩短了急诊诊断和治疗的时间间隔，同时医院死亡率保持不变。这是由于在24小时内住院主治医师值班期间应用了标准化方案。
设立一级创伤中心进行区域化创伤护理可通过缩短时间间隔和改善预后得到证明，但需要充足的资源。
