Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand.
Bureau of Epidemiology, Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand.
West J Emerg Med. 2018 Mar;19(2):266-275. doi: 10.5811/westjem.2017.11.35169. Epub 2018 Feb 20.
Thailand has the highest mortality from road traffic injury (RTI) in the world. There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays.
We conducted a retrospective review study by using a nationwide registry that collected RTI data from all hospitals in Thailand during the New Year holidays in 2008-2015 and Songkran holidays in 2008-2014. A severe RTI patient was defined as one who was admitted, transferred to another hospital, or who died at the emergency department (ED) or during referral. We excluded patients who died at the scene, those who were not transported to the ED, and those who were discharged from the ED. Outcomes associated with EMS utilization were identified by using multiple logistic regression and adjusted by using factors related to injury severity.
Overall we included 100,905 patients in the final analysis; 39,761 severe RTI patients (39.40%; 95% confidence interval [CI] 95% CI [39.10%-39.71%]) used EMS transportation to hospitals. Severe RTI patients transported by EMS had a significantly higher mortality rate in the ED and during referral than that those who were not (2.00% vs. 0.78%, < 0.001). Moreover, EMS use was significantly associated with increased mortality rate in the first 24 hours of admission to hospitals (1.38% for EMS use vs. 0.57% for no EMS use, < 0.001). EMS utilization was a significant predictor of mortality in EDs and during referral (adjusted odds ratio [OR] 2.19; 95% CI [1.88-2.55]), and mortality in the first 24 hours of admission (adjusted OR 2.31; 95% CI [1.95-2.73]).
In this cohort, severe RTI patients transported by EMS had a significantly higher mortality rate than those who went to hospitals using private vehicles during these holidays.
泰国的道路交通伤害（RTI）死亡率居世界之首。在泰国，新年和宋干节等长假期间，通常会有更高的 RTI 发生率。据我们所知，还没有研究描述泰国 RTI 患者使用紧急医疗服务（EMS）的情况。我们试图确定假期中 RTI 患者使用 EMS 的结果。
我们进行了一项回顾性研究，使用全国性登记处，该登记处收集了 2008 年至 2015 年新年假期和 2008 年至 2014 年宋干节假期期间泰国所有医院的 RTI 数据。严重 RTI 患者定义为在急诊室（ED）或转诊期间住院、转院或死亡的患者。我们排除了在现场死亡的患者、未送往 ED 的患者以及从 ED 出院的患者。使用多因素逻辑回归识别与 EMS 使用相关的结局，并通过与损伤严重程度相关的因素进行调整。
我们最终纳入了 100905 例患者进行分析；39761 例严重 RTI 患者（39.40%；95%置信区间[CI]95%CI[39.10%-39.71%]）使用 EMS 转运至医院。与未使用 EMS 转运的患者相比，使用 EMS 转运的严重 RTI 患者在 ED 和转诊期间的死亡率显著更高（2.00%比 0.78%，<0.001）。此外，EMS 使用与住院后 24 小时内死亡率增加显著相关（EMS 使用的死亡率为 1.38%，而无 EMS 使用的死亡率为 0.57%，<0.001）。EMS 使用是 ED 和转诊期间死亡率的显著预测因素（调整后比值比[OR]2.19；95%CI[1.88-2.55]），以及住院后 24 小时内死亡率（调整后 OR 2.31；95%CI[1.95-2.73]）。
在本队列中，与使用私家车前往医院的患者相比，使用 EMS 转运的严重 RTI 患者的死亡率显著更高。
