Katayama Yusuke, Kitamura Tetsuhisa, Kiyohara Kosuke, Iwami Taku, Kawamura Takashi, Hayashida Sumito, Ogura Hiroshi, Shimazu Takeshi
Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan.
Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan.
Acute Med Surg. 2017 Jun 16;4(4):401-407. doi: 10.1002/ams2.291. eCollection 2017 Oct.
Although the prolongation of the time between injury and hospital arrival of traffic accident patients can influence their prognosis, factors associated with the difficulty in hospital acceptance of these patients have not been sufficiently evaluated in Japan.
We retrospectively analyzed the population-based ambulance records of all traffic accident patients for whom the Osaka Municipal Fire Department (Osaka City, Japan) dispatched an ambulance in 2013. We defined "cases with difficulty in hospital acceptance" as cases that required ≥4 calls by emergency medical service personnel at the scene before receiving hospital acceptance. We included patient characteristics (age, sex, coma status, and trauma severity judged by emergency medical service personnel), time factors (day/night or weekday/holiday and weekends), and accident location for multivariable logistic regression analysis to assess factors associated with the difficulty in hospital acceptance.
Among 13,427 traffic accident patients, 2,033 (15.1%) were cases with difficulty in hospital acceptance. Pediatric patients (adjusted odds ratio [OR], 1.265; 95% confidence interval [CI], 1.060-1.509), male sex (adjusted OR, 1.260; 95% CI, 1.135-1.398), moderate-grade trauma (adjusted OR, 2.241; 95% CI, 1.972-2.547), severe-grade trauma (adjusted OR, 2.057; 95% CI, 1.249-3.388), holidays and weekends (adjusted OR, 1.702; 95% CI, 1.539-1.882), and night-time (adjusted OR, 2.720; 95% CI, 2.443-3.027) were positively associated with difficulty in hospital acceptance.
Using population-based ambulance records from a large urban community in Japan, we showed that the difficulty in hospital acceptance of patients at the scene of traffic accidents was positively associated with several prehospital factors.
尽管交通事故患者从受伤到抵达医院的时间延长会影响其预后，但在日本，与这些患者难以被医院收治相关的因素尚未得到充分评估。
我们回顾性分析了2013年日本大阪市消防局派遣救护车的所有交通事故患者基于人群的救护车记录。我们将“难以被医院收治的病例”定义为在获得医院收治前现场急救人员需要呼叫≥4次的病例。我们纳入了患者特征（年龄、性别、昏迷状态以及急救人员判断的创伤严重程度）、时间因素（白天/夜晚或工作日/节假日及周末）以及事故地点进行多变量逻辑回归分析，以评估与难以被医院收治相关的因素。
在13427例交通事故患者中，2033例（15.1%）为难以被医院收治的病例。儿科患者（调整后的优势比[OR]，1.265；95%置信区间[CI]，1.060 - 1.509）、男性（调整后的OR，1.260；95% CI，1.135 - 1.398）、中度创伤（调整后的OR，2.241；95% CI，1.972 - 2.547）、重度创伤（调整后的OR，2.057；95% CI，1.249 - 3.388）、节假日及周末（调整后的OR，1.702；95% CI，1.539 - 1.882）以及夜间（调整后的OR，2.720；95% CI，2.443 - 3.027）与难以被医院收治呈正相关。
通过使用日本一个大型城市社区基于人群的救护车记录，我们表明交通事故现场患者难以被医院收治与几个院前因素呈正相关。
