以色列一级和二级创伤系统中股骨骨折护理结果作为创伤护理衡量指标的研究

Outcome of femoral fractures care as a measure of trauma care between level I and level II trauma systems in Israel.

作者信息

Khoury A, Weil Y, Liebergall M, Mosheiff R

机构信息

Hadassah University Hospital, Jerusalem, Israel.

出版信息

Trauma Surg Acute Care Open. 2016 Dec 1;1(1):e000041. doi: 10.1136/tsaco-2016-000041. eCollection 2016.

DOI:10.1136/tsaco-2016-000041

PMID:29766072

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5891710/

Abstract

BACKGROUND

Our hypothesis in this study was that the outcome of patients with femur fractures would be favorable in a level I trauma center (LITC).

METHODS

A prospective multicenter cohort study. 5 LITC and 6 regional (level II) trauma centers (RTCs) were enrolled to participate in the study. A total of 238 patients suffering from a femoral fracture were recruited to the study. 125 patients were treated in LITCs and 113 in RTCs. Data were extracted from the emergency medical services ambulances, emergency department records, patient hospitalization and discharge records, operating room records, and the national trauma registry (for LITCs). A study questionnaire was administered to all participating patients at discharge, 6 weeks and 6 months postoperatively. The following parameters were studied: mechanism of injury, time from injury to the hospital, Injury Severity Score, classification of femoral fracture, additional injuries, medical history, time to surgery, implant type, skill level of the surgical team, type of anesthesia, length of stay and intensive care unit (ICU) stay, postoperative and intraoperative complications and mortality.

RESULTS

There was a significant difference in the modality of patient transfer between the 2 study groups-with the LITC receiving more patients transported by helicopters or medical intensive care. Time to surgery from admission was shorter in the LITC. Length of stay, ICU stay, and mortality were similar. In the LITCs, 47% of the procedures were performed by residents without the supervision of an attending surgeon, and in the RTCs 79% of the procedures were performed with an senior orthopaedic surgeon. Intraoperative and immediate complication rates were similar among the 2 groups.

CONCLUSIONS

A femoral shaft fracture can be successfully treated in an LITC and RTC in the state of Israel. Both research and policy implementation works are required. Also, a more detailed outcome analysis and triage criteria for emergency are desired.

LEVEL OF EVIDENCE

II.

摘要

背景

我们在本研究中的假设是，股骨骨折患者在一级创伤中心（LITC）的治疗结果会更好。

方法

一项前瞻性多中心队列研究。纳入了5个一级创伤中心和6个地区（二级）创伤中心（RTC）参与研究。共有238例股骨骨折患者被纳入研究。125例患者在一级创伤中心接受治疗，113例在地区创伤中心接受治疗。数据从紧急医疗服务救护车、急诊科记录、患者住院和出院记录、手术室记录以及国家创伤登记处（针对一级创伤中心）提取。在出院时、术后6周和6个月对所有参与研究的患者进行问卷调查。研究了以下参数：损伤机制、受伤至入院时间、损伤严重程度评分、股骨骨折分类、其他损伤、病史、手术时间、植入物类型、手术团队技术水平、麻醉类型、住院时间和重症监护病房（ICU）住院时间、术后和术中并发症及死亡率。

结果

两个研究组在患者转运方式上存在显著差异——一级创伤中心接收更多由直升机或医疗重症监护转运的患者。从入院到手术的时间在一级创伤中心更短。住院时间、ICU住院时间和死亡率相似。在一级创伤中心，47%的手术由住院医师在没有主治医生监督的情况下进行，而在地区创伤中心，79%的手术由资深骨科医生进行。两组术中及即刻并发症发生率相似。