与滑雪和单板滑雪相关的严重损伤：一项国家创伤数据库研究。
Severe injuries associated with skiing and snowboarding: A national trauma data bank study.
作者信息
de Roulet Amory, Inaba Kenji, Strumwasser Aaron, Chouliaras Konstantinos, Lam Lydia, Benjamin Elizabeth, Grabo Daniel, Demetriades Demetrios
机构信息
From the Keck School of Medicine of the University of Southern California; Division of Acute Care Surgery and Surgical Critical Care (A.D., K.I., A.S., K.C., D.D.), LAC+USC Medical Center; and Department of General Surgery (K.C.), Wake Forest School of Medicine.
出版信息
J Trauma Acute Care Surg. 2017 Apr;82(4):781-786. doi: 10.1097/TA.0000000000001358.
BACKGROUND
Injuries after skiing and snowboarding accidents lead to an estimated 7,000 hospital admissions annually and present a significant burden to the health care system. The epidemiology, injury patterns, hospital resource utilization, and outcomes associated with these severe injuries need further characterization.
METHODS
The National Trauma Data Bank was queried for the period 2007 to 2014 for admissions with Injury Severity Score > 15 and International Classification of Diseases Codes-9th Revision codes 885.3 (fall from skis, n = 1,353) and 885.4 (fall from snowboard, n = 1,216). Demographics, emergency department data, diagnosis and procedure codes, and outcomes were abstracted from the database.
RESULTS
Severe (Injury Severity Score > 15) ski-associated and snowboard-associated injuries differed with respect to age distribution (median age, 38; interquartile range, 19-59 for skiers and median age, 20; interquartile range, 16-25 for snowboarders; p < 0.001) and sex (78.9% and 86.4% males, respectively, p < 0.001). Traumatic brain injury was common for both sports (56.8% of skiers vs. 46.6% of snowboarders, p < 0.001). Injuries to the spine (28.9%), chest (37.6%), and abdomen (35.0%) were also common. Eighty percent of patients used emergency medical services (50% ambulance, 30% helicopter) with a median emergency medical services transport time of 84 minutes. 50.8% of patients required interhospital transport. 43.2% of injuries required surgical intervention (21.3% orthopedic, 12.5% neurosurgical, 10.5% thoracic, 7.8% abdominal). Median hospital length of stay was 5.0 days. 60.0% of patients required intensive care unit admission with median intensive care unit length of stay 3.0 days. Overall mortality was 4.0% for skiers and 1.9% for snowboarders.
CONCLUSION
Severe injuries after ski and snowboard accidents are associated with significant morbidity and mortality. Differences in injury patterns, risk factors for severe injury, and resource utilization require further study. Increased resource allocation to alpine trauma systems is warranted.
LEVEL OF EVIDENCE
Prognostic/epidemiologic, level III.
背景
滑雪和单板滑雪事故导致的损伤估计每年有7000例住院病例，给医疗保健系统带来了沉重负担。与这些严重损伤相关的流行病学、损伤模式、医院资源利用情况及治疗结果需要进一步明确。
方法
查询国家创伤数据库2007年至2014年期间损伤严重程度评分>15且国际疾病分类第九版编码为885.3（从滑雪板上跌落，n = 1353）和885.4（从单板上跌落，n = 1216）的住院病例。从数据库中提取人口统计学、急诊科数据、诊断和手术编码以及治疗结果。
结果
严重（损伤严重程度评分>15）的滑雪相关损伤和单板滑雪相关损伤在年龄分布（滑雪者的中位年龄为38岁；四分位间距为19 - 59岁，单板滑雪者的中位年龄为20岁；四分位间距为16 - 25岁；p < 0.001）和性别方面存在差异（男性分别占78.9%和86.4%，p < 0.001）。两种运动中创伤性脑损伤都很常见（滑雪者中占56.8%，单板滑雪者中占46.6%，p < 0.001）。脊柱损伤（28.9%）、胸部损伤（37.6%）和腹部损伤（35.0%）也很常见。80%的患者使用了紧急医疗服务（50%使用救护车，30%使用直升机），紧急医疗服务运输时间的中位数为84分钟。50.8%的患者需要院间转运。43.2%的损伤需要手术干预（21.3%为骨科手术，12.5%为神经外科手术，10.5%为胸外科手术，7.8%为腹部手术）。住院时间中位数为5.0天。60.0%的患者需要入住重症监护病房，重症监护病房住院时间中位数为3.0天。滑雪者的总体死亡率为4.0%，单板滑雪者为1.9%。
结论
滑雪和单板滑雪事故后的严重损伤与显著的发病率和死亡率相关。损伤模式、严重损伤的危险因素以及资源利用方面的差异需要进一步研究。有必要增加对高山创伤系统的资源分配。
证据级别
预后/流行病学，III级。
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