Bradley Nori L, Garraway Naisan, Bell Nathaniel, Lakha Nasira, Hameed S Morad
Department of Trauma, Acute Care Surgery and Critical Care, University of British Columbia, Canada.
College of Nursing, University of South Carolina, United States.
Injury. 2017 May;48(5):1069-1073. doi: 10.1016/j.injury.2016.11.004. Epub 2016 Nov 5.
Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer.
We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243). Completion rates of paramedic form and ATLS primary survey variables were extracted. Nominal and interval descriptives were calculated. Documentation rates were considered deficient at <80% and severely deficient <60%. Odds ratios were calculated for primary facility data based on ISS ≥30 vs ISS <30, with 2-sided p-values for confidence intervals RESULTS: Two hundred forty-three patients met inclusion criteria with a mean ISS of 26. Most injured patients were male (79%), the predominant mechanism was blunt (93%) and the average age at injury was 51 years old. Two hundred eighteen patients arrived by Emergency Health Services, and 140 (64%) of EHS pre-hospital forms were transferred with the patient chart. Pre-hospital airway, physiologic data, and GCS completion rates were severely deficient (43-49%). Primary facility data was adequately completed for airway management, systolic blood pressure, and heart rate in (80-83%). Completion rates were deficient for respiratory rate, GCS and temperature (60-77%). An ISS score ≥30 was significantly associated with a lower completion rate for GCS.
Overall, documentation for inter-hospital transfer of major trauma patients in BC has significant deficiencies. Physiologic and basic ATLS variables are often omitted in transferred charts. The potential for adverse events is high but performance improvement is achievable. We recommend education, training and a standardized trauma transfer protocol to improve system-wide information transfer.
从农村地区转至城市中心的创伤幸存者死亡率高于直接入住城市中心的创伤患者。创伤登记中的转运数据对于伤害控制很重要。院前和早期生理数据可能反映院前护理过程。不列颠哥伦比亚省目前没有创伤患者数据转运的标准化流程。
我们对在1年期间转至一级创伤中心的重大创伤患者（损伤严重度评分>15）进行了回顾性数据分析（n = 243）。提取了护理人员表格和高级创伤生命支持（ATLS）初级评估变量的完成率。计算了名义和区间描述性统计量。记录率<80%被视为不足，<60%被视为严重不足。基于损伤严重度评分≥30与<30计算了初级医疗机构数据的比值比，并给出双侧p值用于置信区间。
243例患者符合纳入标准，平均损伤严重度评分为26。大多数受伤患者为男性（79%），主要致伤机制为钝性伤（93%），平均受伤年龄为51岁。218例患者由紧急医疗服务机构送来，其中140例（64%）的紧急医疗服务院前表格随患者病历一同转运。院前气道、生理数据和格拉斯哥昏迷量表（GCS）完成率严重不足（43 - 49%）。初级医疗机构数据在气道管理、收缩压和心率方面的完成情况良好（80 - 83%）。呼吸频率、GCS和体温的完成率不足（60 - 77%）。损伤严重度评分≥30与GCS较低的完成率显著相关。
总体而言，不列颠哥伦比亚省重大创伤患者院间转运的记录存在显著不足。转运病历中常常遗漏生理和基本的高级创伤生命支持变量。不良事件发生的可能性很高，但性能改进是可以实现的。我们建议开展教育、培训并制定标准化的创伤转运方案，以改善全系统的信息传递。
