Martinez Benjamin, Owings John T, Hector Christopher, Hargrove Paige, Tanaka Shoichiro, Moore Margaret, Greiffenstein Patrick, Giaimo Joseph, Talebinejad Shahrzad, Hunt John P
Louisiana State University Health Sciences Center, New Orleans, LA Ochsner Medical Center, New Orleans, LA Our Lady of the Lake Regional Medical Center, Baton Rouge, LA Louisiana Emergency Response Network, Baton Rouge, LA.
J Am Coll Surg. 2017 Oct;225(4):508-515. doi: 10.1016/j.jamcollsurg.2017.06.016. Epub 2017 Aug 30.
The Louisiana Emergency Response Network (LERN), a statewide trauma system, has a single communication center with real-time data on hospital capacity across the state. With these data, scene information, and a standardized triage protocol, prehospital providers are directed to the most appropriate hospital. The purpose of our study was to compare outcomes between those patients who complied with the LERN communication center direction and those who did not.
Trauma patients directed by LERN from the field in 2014 were included. Patients who followed the LERN communication center direction were considered the compliant group. Patients brought to a hospital inconsistent with the LERN direction were considered the noncompliant group. Chi-square analysis was used to compare differences between groups and a p value of <0.05 was considered statistically significant.
During the study period, LERN directed 14,071 patients to a destination hospital. Prehospital providers were compliant with the LERN direction in 13,037 (92.7%) patients and noncompliant in 1,034 (7.3%) patients. There were fewer patients in the compliant group (570 of 13,037 [4.3%]) requiring transfer to a second hospital than in the noncompliant group (312 of 1,034 [30.2%]) (p < 0.01). The mortality rate was lower in the compliant group (81 of 13,037 [0.6%]) than in the noncompliant group (21 of 1,034 [2.03%]) (p < 0.01).
Following direction from a central communication center with real-time hospital capacity data yielded a 6-fold decrease in secondary transfer and a 3-fold decrease in mortality. These data emphasize the value of an organized statewide trauma network that routes patients to the appropriate facilities.
路易斯安那州应急响应网络（LERN）是一个全州范围的创伤系统，拥有一个单一的通信中心，具备全州医院容量的实时数据。利用这些数据、现场信息以及标准化的分诊协议，院前急救人员会被指引至最合适的医院。我们研究的目的是比较遵循LERN通信中心指引的患者与未遵循指引的患者之间的治疗结果。
纳入2014年由LERN从现场指引的创伤患者。遵循LERN通信中心指引的患者被视为依从组。被送至与LERN指引不符的医院的患者被视为不依从组。采用卡方分析比较组间差异，p值<0.05被认为具有统计学意义。
在研究期间，LERN将14,071名患者指引至目的地医院。院前急救人员在13,037名（92.7%）患者中遵循了LERN的指引，在1,034名（7.3%）患者中未遵循指引。依从组中需要转至第二家医院的患者（13,037名中的570名[4.3%]）少于不依从组（1,034名中的312名[30.2%]）（p<0.01）。依从组的死亡率（13,037名中的81名[0.6%]）低于不依从组（1,034名中的21名[2.03%]）（p<0.01）。
遵循具有实时医院容量数据的中央通信中心的指引，二次转运减少了6倍，死亡率降低了3倍。这些数据强调了一个有组织的全州范围创伤网络将患者送至合适医疗机构的价值。
