澳大利亚维多利亚州院前潜在脊髓损伤的流行病学：一项为期六年的回顾性队列研究。
The epidemiology of pre-hospital potential spinal cord injuries in Victoria, Australia: a six year retrospective cohort study.
作者信息
Oteir Ala'a O, Smith Karen, Stoelwinder Johannes U, Cox Shelley, Middleton James W, Jennings Paul A
机构信息
Department of Community Emergency Health and Paramedic Practice, Monash University, Building 3, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.
出版信息
Inj Epidemiol. 2016 Dec;3(1):25. doi: 10.1186/s40621-016-0089-0. Epub 2016 Oct 17.
BACKGROUND
Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI.
METHODS
This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI. Data was extracted from the AV data warehouse, including demographic details, trauma aetiology, paramedic assessment, management and other event characteristics.
RESULTS
A total of 106,059cases were included in the study, representing 2.3 % of all emergency transports by AV. Subjects had a median age of 51 years (interquartile range; 29-78) and 52.4 % were males (95 % CI 52-52.7). Males were significantly younger than females (M: 43 years [26-65] vs. F: 64 years [36-84], p =0.001). Falls and traffic accidents were the leading causes of injuries, comprising 46.9 and 39.4 % of cases, respectively. Other causes included accidents due to sport, animals, industrial work and diving, as well as violence and hanging. 29.9 % of patients were transported to a Major Trauma Service (MTS). A proportion of 48.8 % of the study population met the Pre-hospital Major Trauma criteria.
CONCLUSION
This is the first study to describe the epidemiology of potential TSCI in Australia and is based on a large, state-wide sample. It provides background knowledge and a baseline for future research, as well as a reference point for future in policy. Falling and traffic related injuries were the leading causes of potential SCI. Future research is required to identify the proportion of confirmed TSCI among the potentials and factors associated with TSCI in prehospital settings.
背景
创伤性脊髓损伤（TSCI）相对不常见，但却是一种具有毁灭性且代价高昂的病症。尽管其对人类和社会有影响，但描述院前环境中潜在TSCI患者的研究却很匮乏。本文旨在描述护理人员认为可能有TSCI风险或疑似患有TSCI的患者的流行病学情况，以便更好地了解与潜在TSCI相关的因素。
方法
这是一项回顾性队列研究，研究对象为2007年1月1日至2012年12月31日期间由维多利亚救护车服务中心（AV）接诊和转运的所有成年患者，这些患者基于符合院前分诊方案和脊柱检查标准、护理人员的怀疑或脊柱固定情况，被归类为有TSCI风险或疑似患有TSCI。数据从AV数据仓库中提取，包括人口统计学细节、创伤病因、护理人员评估、处理情况及其他事件特征。
结果
该研究共纳入106,059例病例，占AV所有紧急转运病例的2.3%。研究对象的年龄中位数为51岁（四分位间距为29 - 78岁），52.4%为男性（95%置信区间为52 - 52.7%）。男性明显比女性年轻（男性：43岁[26 - 65岁]，女性：64岁[36 - 84岁]，p = 0.001）。跌倒和交通事故是主要的致伤原因，分别占病例的46.9%和39.4%。其他原因包括运动、动物、工业作业和潜水导致的事故，以及暴力和上吊。29.9%的患者被转运至重大创伤服务机构（MTS）。48.8%的研究人群符合院前重大创伤标准。
结论
这是第一项描述澳大利亚潜在TSCI流行病学情况的研究，基于一个全州范围的大样本。它为未来研究提供了背景知识和基线，也为未来政策制定提供了参考点。跌倒和交通相关损伤是潜在SCI的主要原因。未来需要开展研究，以确定潜在病例中确诊TSCI的比例以及院前环境中与TSCI相关的因素。
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