McKechnie P S, Kerslake D A, Parks R W
Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
World J Surg. 2017 Jul;41(7):1796-1800. doi: 10.1007/s00268-017-3934-6.
To assess the time taken to CT and emergency surgery for trauma patients with an injury to liver, spleen or pancreas prior to the introduction of major trauma centres (MTCs) in Scotland.
A search was performed of the Scottish Trauma Audit Group database for any patient with relevant injuries over a 2-year period. Primary outcome measures were time to CT and emergency surgery. Patient demographics were also recorded.
A total of 211 patients were identified of whom 23 had more than one organ affected. There were a total of 234 injuries (123 liver, 99 splenic and 12 pancreatic) in these patients. A total of 160 injuries (75.8%) suffered blunt trauma. Of 211 patients, 157 underwent emergency CT with a median time to scan of 73 min (range 4-474). Hospitals provisionally designated as MTCs were 9 min faster than non-MTCs in time to CT. There was no difference in time of day. Ninety-nine patients had surgery within 24 h at a median time of 200 min. Twenty-five patients with hypotension on presentation took a median time of 130 min. Only 44 patients (27%) had a CT or emergency surgery within the expected MTC target of 1 h. Thirty-nine patients required transfer to another centre.
Current management of patients with abdominal trauma and haemodynamic instability remains sub-optimal in Scotland when compared to recognized performance indicators of CT and emergency surgery within 1 h. Implementation of a major trauma network in Scotland should improve access to emergency radiology and surgery and efforts to shorten current timelines should improve patient outcomes.
评估在苏格兰引入大型创伤中心（MTC）之前，肝、脾或胰腺损伤的创伤患者进行CT检查和急诊手术所需的时间。
对苏格兰创伤审计小组数据库进行检索，查找2年内有相关损伤的任何患者。主要结局指标是进行CT检查和急诊手术的时间。还记录了患者的人口统计学数据。
共识别出211例患者，其中23例有多个器官受影响。这些患者共有234处损伤（123处肝脏损伤、99处脾脏损伤和12处胰腺损伤）。共有160处损伤（75.8%）为钝性创伤。在211例患者中，157例接受了急诊CT检查，扫描的中位时间为73分钟（范围4 - 474分钟）。临时指定为MTC的医院在进行CT检查的时间上比非MTC医院快9分钟。一天中的不同时间没有差异。99例患者在24小时内进行了手术，中位时间为200分钟。25例就诊时出现低血压的患者中位时间为130分钟。只有44例患者（27%）在预期的MTC目标1小时内进行了CT检查或急诊手术。39例患者需要转至另一中心。
与公认的1小时内进行CT检查和急诊手术的绩效指标相比，苏格兰目前对腹部创伤和血流动力学不稳定患者的管理仍未达到最佳水平。在苏格兰实施大型创伤网络应能改善急诊放射学检查和手术的可及性，努力缩短当前的时间线应能改善患者预后。
