警方转运与地面紧急医疗服务：创伤系统层面的院前护理政策评估及其对临床结局的影响。
Police transport versus ground EMS: A trauma system-level evaluation of prehospital care policies and their effect on clinical outcomes.
作者信息
Wandling Michael W, Nathens Avery B, Shapiro Michael B, Haut Elliott R
机构信息
From the Division of Trauma & Critical Care, Department of Surgery (M.W.W., M.B.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center, Department of Surgery (M.W.W.), Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Research and Optimal Patient Care (M.W.W.), American College of Surgeons, Chicago, Illinois; Department of Surgery (A.B.N.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Acute Care Surgery, Department of Surgery (E.R.H.), The Johns Hopkins School of Medicine, Baltimore, Maryland; and The Johns Hopkins University School of Public Health (E.R.H.), Baltimore, Maryland.
出版信息
J Trauma Acute Care Surg. 2016 Nov;81(5):931-935. doi: 10.1097/TA.0000000000001228.
BACKGROUND
Rapid transport to definitive care ("scoop and run") versus field stabilization in trauma remains a topic of debate and has resulted in variability in prehospital policy. We aimed to identify trauma systems frequently using a true "scoop and run" police transport approach and to compare mortality rates between police and ground emergency medical services (EMS) transport.
METHODS
Using the National Trauma Databank (NTDB), we identified adult gunshot and stab wound patients presenting to Level 1 or 2 trauma centers from 2010 to 2012. Hospitals were grouped into their respective cities and regional trauma systems. Patients directly transported by police or ground EMS to trauma centers in the 100 most populous US trauma systems were included. Frequency of police transport was evaluated, identifying trauma systems with high utilization. Mortality rates and risk-adjusted odds ratio for mortality for police versus EMS transport were derived.
RESULTS
Of 88,564 total patients, 86,097 (97.2%) were transported by EMS and 2,467 (2.8%) by police. Unadjusted mortality was 17.7% for police transport and 11.6% for ground EMS. After risk adjustment, patients transported by police were no more likely to die than those transported by EMS (OR = 1.00, 95% CI: 0.69-1.45). Among all police transports, 87.8% occurred in three locations (Philadelphia, Sacramento, and Detroit). Within these trauma systems, unadjusted mortality was 19.9% for police transport and 13.5% for ground EMS. Risk-adjusted mortality was no different (OR = 1.01, 95% CI: 0.68-1.50).
CONCLUSIONS
Using trauma system-level analyses, patients with penetrating injuries in urban trauma systems were found to have similar mortality for police and EMS transport. The majority of prehospital police transport in penetrating trauma occurs in three trauma systems. These cities represent ideal sites for additional system-level evaluation of prehospital transport policies.
LEVEL OF EVIDENCE
Prognostic/epidemiologic study, level III.
背景
创伤患者快速转运至确定性治疗机构（“抱起就走”）与现场稳定病情后再转运相比，仍是一个存在争议的话题，这也导致了院前急救政策的差异。我们旨在确定经常采用真正“抱起就走”警察转运方式的创伤系统，并比较警察转运与地面紧急医疗服务（EMS）转运的死亡率。
方法
利用国家创伤数据库（NTDB），我们确定了2010年至2012年期间前往一级或二级创伤中心就诊的成年枪伤和刺伤患者。医院按照各自所在城市和区域创伤系统进行分组。纳入了由警察或地面EMS直接转运至美国100个人口最多的创伤系统中的创伤中心的患者。评估警察转运的频率，确定高利用率的创伤系统。得出警察转运与EMS转运的死亡率及死亡风险调整比值比。
结果
在总共88564例患者中，86097例（97.2%）由EMS转运，2467例（2.8%）由警察转运。警察转运的未调整死亡率为17.7%，地面EMS转运的为11.6%。经过风险调整后，由警察转运的患者死亡可能性并不高于由EMS转运的患者（比值比=1.00，95%置信区间：0.69 - 1.45）。在所有警察转运中，87.8%发生在三个地点（费城、萨克拉门托和底特律）。在这些创伤系统中，警察转运的未调整死亡率为19.9%，地面EMS转运的为13.5%。风险调整后的死亡率无差异（比值比=1.01，95%置信区间：0.68 - 1.50）。
结论
通过创伤系统层面的分析，发现城市创伤系统中穿透伤患者由警察转运和EMS转运的死亡率相似。穿透伤院前警察转运大多发生在三个创伤系统。这些城市是对院前转运政策进行额外系统层面评估的理想地点。
证据级别
预后/流行病学研究，三级。
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