Jones Peter G, Kool Bridget, Dalziel Stuart, Shepherd Michael, Le Fevre James, Harper Alana, Wells Susan, Stewart Joanna, Curtis Elana, Reid Papaarangi, Ameratunga Shanthi
Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
J Paediatr Child Health. 2017 Jul;53(7):685-690. doi: 10.1111/jpc.13519. Epub 2017 Apr 13.
Timely access to computerised tomography (CT) for acute traumatic brain injuries (TBIs) facilitates rapid diagnosis and surgical intervention. In 2009, New Zealand introduced a mandatory target for emergency department (ED) stay such that 95% of patients should leave ED within 6 h of arrival. This study investigated whether this target influenced the timeliness of cranial CT scanning in children who presented to ED with acute TBI.
We retrospectively reviewed a random sample of charts of children <15 years with acute TBI from 2006 to 2012. Cases were identified using International Classification of Disease 10 codes consistent with TBI. General linear models investigated changes in time to CT and other indicators before and after the shorter stays in ED target was introduced in 2009.
Among the 190 cases eligible for study (n = 91 pre-target and n = 99 post-target), no significant difference was found in time to CT scan pre- and post-target: least squares mean (LSM) with 95% confidence interval = 68 (56-81) versus 65 (53-78) min, respectively, P = 0.66. Time to neurosurgery (LSM 8.7 (5-15) vs. 5.1 (2.6-9.9) h, P = 0.19, or hospital length of stay (LSM: 4.9 (3.9-6.3) vs. 5.2 (4.1-6.7) days, P = 0.69) did not change significantly. However, ED length of stay decreased by 45 min in the post-target period (LSM = 211 (187-238) vs. 166 (98-160) min, P = 0.006).
Implementation of the shorter stays in ED target was not associated with a change in the time to CT for children presenting with acute TBI, but an overall reduction in the time spent in ED was apparent.
对于急性创伤性脑损伤（TBI）患者，及时进行计算机断层扫描（CT）有助于快速诊断和手术干预。2009年，新西兰引入了急诊科（ED）停留时间的强制性目标，即95%的患者应在到达后6小时内离开急诊科。本研究调查了该目标是否影响了因急性TBI就诊于急诊科的儿童进行头颅CT扫描的及时性。
我们回顾性地随机抽取了2006年至2012年15岁以下急性TBI儿童的病历样本。使用与TBI一致的国际疾病分类第10版代码识别病例。通用线性模型研究了2009年引入较短的急诊科停留时间目标前后CT检查时间及其他指标的变化。
在190例符合研究条件的病例中（目标实施前n = 91例，目标实施后n = 99例），目标实施前后CT扫描时间无显著差异：最小二乘均值（LSM）及其95%置信区间分别为68（56 - 81）分钟和65（53 - 78）分钟，P = 0.66。神经外科手术时间（LSM 8.7（5 - 15）小时对5.1（2.6 - 9.9）小时，P = 0.19）或住院时间（LSM：4.9（3.9 - 6.3）天对5.2（4.1 - 6.7）天，P = 0.69）均无显著变化。然而，目标实施后急诊科停留时间减少了45分钟（LSM = 211（187 - 238）分钟对166（98 - 160）分钟，P = 0.006）。
实施较短的急诊科停留时间目标与急性TBI儿童进行CT检查的时间变化无关，但急诊科停留的总时间明显减少。
