North East Ambulance Service NHS Foundation Trust, Trauma Desk, Bernicia House, Goldcrest Way, Newcastle Upon Tyne, NE15 8NY, UK.
Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, NE7 7XA, UK.
Scand J Trauma Resusc Emerg Med. 2017 Aug 23;25(1):83. doi: 10.1186/s13049-017-0419-4.
Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for adults aged less than 45 years old. This study aimed to identify pre-hospital factors associated with patient outcomes for major trauma within one Regional Trauma Network.
Secondary analysis of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (TARN) was undertaken. The primary outcome used in analysis was 'Status at Discharge' (alive/deceased). Independent variables considered included 'Casualty Characteristics' such as mechanism of injury (MOI), age, and physiological measurements, as well as 'Response Characteristics' such as response timings and skill mix. Binary Logistic Regression analysis using the 'forward stepwise' method was undertaken for physiological measures taken at the scene.
The study analysed 1033 major trauma records (mean age of 38.5 years, SD 21.5, 95% CI 37-40). Adults comprised 82.6% of the sample (n = 853), whilst 12.9% of the sample were children (n = 133). Men comprised 68.5% of the sample (n = 708) in comparison to 28.8% women (n = 298). Glasgow Coma Score (GCS) (p < 0.000), Respiration Rate (p < 0.001) and Age (p < 0.000), were all significant when associated with the outcome 'Status at Discharge' (alive/deceased). Isolated bivariate associations provided tentative support for response characteristics such as existing dispatching practices and the value of rapid crew arrival. However, these measurements appear to be of limited utility in predictive modelling of outcomes.
The complexity of physiological indices potentially complicate their predictive utility e.g. whilst a Systolic Blood Pressure (SBP) of < 90 mmHg serves as a trigger for bypass to a Major Trauma Centre, the utility of this observation is nullified in cases of Traumatic Brain Injury. Analysis suggested that as people age, outcomes from major trauma significantly worsened. This finding is consistent with existing research highlighting the relationship between trauma in elderly patients and poorer outcomes.
Findings lend further validity to GCS, Respiration Rate and Age as predictive triggers for transport to a Major Trauma Centre. Analysis of interactions between response times, skill mix and triage demand further exploration but tentatively support the 'Golden Hour' concept and suggest a potential 'load and go and play on the way' approach.
在英国（UK），成年人年龄在 45 岁以下时，严重创伤通常是危及生命的，也是导致死亡的主要原因。本研究旨在确定与一个区域创伤网络内严重创伤患者预后相关的院前因素。
对创伤审核研究网络（TARN）的院前审核数据和患者结果数据进行二次分析。分析中使用的主要结果是“出院时的状态”（存活/死亡）。考虑的独立变量包括创伤机制（MOI）、年龄和生理测量等“伤员特征”，以及反应时间和技能组合等“反应特征”。对现场采集的生理测量值进行了使用“逐步向前”方法的二元逻辑回归分析。
该研究分析了 1033 份严重创伤记录（平均年龄 38.5 岁，标准差 21.5，95%置信区间 37-40）。成年人占样本的 82.6%（n=853），而样本中 12.9%为儿童（n=133）。男性占样本的 68.5%（n=708），而女性占 28.8%（n=298）。格拉斯哥昏迷评分（GCS）（p<0.000）、呼吸频率（p<0.001）和年龄（p<0.000）与“出院时的状态”（存活/死亡）相关时均具有显著意义。孤立的双变量关联为现有调度实践和快速机组到达的价值等反应特征提供了初步支持。然而，这些测量值在预测结果方面似乎没有太大的作用。
生理指数的复杂性可能会使其预测效用复杂化，例如，虽然收缩压（SBP）<90mmHg 是将患者转至重大创伤中心的触发因素，但在创伤性脑损伤的情况下，这一观察结果的作用就会失效。分析表明，随着年龄的增长，严重创伤的结果显著恶化。这一发现与现有的研究结果一致，即老年人的创伤与较差的结果有关。
研究结果进一步证明格拉斯哥昏迷评分（GCS）、呼吸频率和年龄是转运至重大创伤中心的预测触发因素。对反应时间、技能组合和分诊需求之间的相互作用进行分析需要进一步探讨，但初步支持“黄金一小时”的概念，并暗示可能存在“负荷后直接转运，途中进行治疗”的方法。
