Kim Jungeun, Song Kyoung Jun, Shin Sang Do, Ro Young Sun, Hong Ki Jeong, Holmes James F
Prehosp Emerg Care. 2017 Jul-Aug;21(4):466-475. doi: 10.1080/10903127.2017.1294223. Epub 2017 May 10.
Prehospital time potentially impacts clinical outcomes in severely injured trauma patients. The importance of individual components, including scene and response time, however, is controversial. Our objective was to determine the impact of prehospital times on survival in severely injured patients.
We reviewed injured trauma patients enrolled in a Korean EMS trauma registry during 2012. Severe trauma patients were defined as having either a "V" or lower in the AVPU system, a systolic blood pressure ≤90mmHg, or respiratory rate <10 or >29. Patients with Injury Severity Scores(ISS) < 9 were excluded. Patients were categorized by scene time into 4 groups as follows: <3 minutes, 3-6 minutes, 6-9 minutes, and ≥9 minutes and by prehospital time as follows: <16 minutes, 16-24 minutes, 24-32 minutes, and ≥32 minutes. The primary outcome was in-hospital mortality. Multiple linear regression analysis was used to adjust for possible confounders.
A total of 2,257 eligible patients were analyzed. Scene time was <3 minutes in 220 (9.7%), 3-6 in 865 (38.3%), 6-9 in 587 (26.0%), and ≥9 in 585 (25.9%). In-hospital mortality was 396 (17.5%). Compared to a scene time 6 to 9 minutes, mortality was higher as the scene time decreased: odds ratio (OR) = 1.3(3 to <6), OR = 1.9(0 to <3). Mortality was slightly decreased as prehospital time increased, OR = 1.0(16 to <24), OR = 0.9(24 to <32), OR = 0.7(≥32).
Longer prehospital times did not increase mortality in severely injured trauma patients in Korea. Furthermore, longer scene times were associated with lower mortality.
院前时间可能会影响重伤创伤患者的临床结局。然而，包括现场时间和反应时间在内的各个组成部分的重要性存在争议。我们的目的是确定院前时间对重伤患者生存的影响。
我们回顾了2012年纳入韩国紧急医疗服务创伤登记系统的受伤创伤患者。严重创伤患者定义为在AVPU系统中为“V”或更低、收缩压≤90mmHg、呼吸频率<10或>29。损伤严重度评分（ISS）<9的患者被排除。患者按现场时间分为4组：<3分钟、3 - 6分钟、6 - 9分钟和≥9分钟，按院前时间分为：<16分钟、16 - 24分钟、24 - 32分钟和≥32分钟。主要结局是院内死亡率。采用多元线性回归分析来调整可能的混杂因素。
共分析了2257例符合条件的患者。现场时间<3分钟的有220例（9.7%），3 - 6分钟的有865例（38.3%），6 - 9分钟的有587例（26.0%），≥9分钟的有585例（25.9%）。院内死亡率为396例（17.5%）。与现场时间6至9分钟相比，随着现场时间减少死亡率更高：比值比（OR）=1.3（3至<6），OR =1.9（0至<3）。随着院前时间增加死亡率略有下降，OR =1.0（16至<24），OR =0.9（24至<32），OR =0.7（≥32）。
在韩国，较长的院前时间并未增加重伤创伤患者的死亡率。此外，较长的现场时间与较低的死亡率相关。
