Prabhakaran Kartik, Petrone Patrizio, Lombardo Gary, Stoller Christy, Policastro Anthony, Marini Corrado P
Division of Trauma Surgery, Surgical Critical Care and Emergency General Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, New York.
Division of Trauma Surgery, Surgical Critical Care and Emergency General Surgery, Winthrop University Hospital, Mineola, New York.
J Surg Res. 2017 Nov;219:66-71. doi: 10.1016/j.jss.2017.05.103. Epub 2017 Jun 23.
Direct transport of patients with severe traumatic brain injury (sTBI) to trauma centers (TCs) that can provide definitive care results in lower mortality rates. This study investigated the impact of direct versus nondirect transfers on the mortality rates of patients with sTBI.
Data on patients with TBI admitted between January 1, 2012, and December 31, 2013, to our Level I TC were obtained from the trauma registry. Data included patient age, sex, mechanism, and type of injury, comorbidities, Glasgow Coma Scale, Injury Severity scores, prehospital time, time to request and to transfer, time to initiation of multimodality monitoring and goal-directed therapy protocol, dwell time in the emergency department (EDT), and mortality. Data, reported in means ± standard deviation, were analyzed with the Student t-test and chi-square. Statistical significance was accepted at a P value < 0.05.
sTBI direct transfer to TC versus transfer from non-TCs (NTC): Of the 1187 patients with TBI admitted to our TC, 768 (64.7%) were admitted directly from the scene, whereas 419 (35.3%) were admitted after secondary transfer. One hundred seventy-one (22.2%) of the direct transfers had Glasgow Coma Scale < 8 (sTBI) and 92 (21.9%) of the secondary transfers had sTBI. The transfer time: Time from scene to arrival to the EDT was significantly shorter for TC versus NTCs 43 ± 14 versus 77 ± 26 min, respectively (P < 0.05). EDT dwell time before transfer and time from injury to arrival to TC were 4.2 ± 2.1 and 6.2 ± 8.3 h, respectively. Mortality: There was a statistically significant lower mortality for patients with sTBI transferred directly from the scene to TCs as opposed to patients secondarily transferred, 33/171 (19.3%) versus 33/92 (35.8%), respectively (P < 0.05).
To decrease TBI-related mortality, patients with suspected sTBI should be taken directly to a Level I or II TC unless they require life-saving stabilization at NTCs.
将重度创伤性脑损伤（sTBI）患者直接转运至能够提供确定性治疗的创伤中心（TCs）可降低死亡率。本研究调查了直接转运与非直接转运对sTBI患者死亡率的影响。
从创伤登记处获取2012年1月1日至2013年12月31日期间入住我院一级TC的TBI患者的数据。数据包括患者年龄、性别、受伤机制和类型、合并症、格拉斯哥昏迷量表、损伤严重程度评分、院前时间、请求转运和实际转运时间、启动多模式监测和目标导向治疗方案的时间、在急诊科的停留时间（EDT）以及死亡率。数据以均值±标准差表示，采用学生t检验和卡方检验进行分析。P值<0.05时具有统计学意义。
sTBI患者直接转运至TC与从非TCs（NTCs）转运的情况：在我院TC收治的1187例TBI患者中，768例（64.7%）直接从现场入院，而419例（35.3%）为二次转运后入院。直接转运的患者中有171例（22.2%）格拉斯哥昏迷量表<8分（sTBI），二次转运的患者中有92例（21.9%）为sTBI。转运时间：从现场到到达EDT的时间，TC组显著短于NTCs组，分别为43±14分钟和77±26分钟（P<0.05）。转运前的EDT停留时间以及从受伤到到达TC的时间分别为4.2±2.1小时和6.2±8.3小时。死亡率：与二次转运的患者相比，直接从现场转运至TC的sTBI患者死亡率在统计学上显著更低，分别为33/171（19.3%）和33/92（35.8%）（P<0.05）。
为降低TBI相关死亡率，疑似sTBI患者应直接送往一级或二级TC，除非他们需要在NTCs进行挽救生命的稳定治疗。
