From the Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington.
Anesth Analg. 2019 Jul;129(1):141-146. doi: 10.1213/ANE.0000000000003651.
Virtually all anesthesiologists care for patients who sustain traumatic injuries; however, the frequency with which operative anesthesia care is provided to this specific patient population is unclear. We sought to better understand the degree to which anesthesia providers participate in operative trauma care and how this differs by trauma center designation (levels I-V), using data from a comprehensive, regional database-the Washington State Trauma Registry (WSTR). We also sought to specifically assess operative anesthesia care frequency vis a vis the American College of Surgeons guidelines for continuous anesthesiology coverage for Level II trauma center accreditation.
We conducted a retrospective analysis measuring the frequency of operative anesthesia care among patients enrolled in the WSTR. Univariate comparisons were made between trauma patients who had surgery during their admission and those who did not (medical management only). In addition, clinical factors associated with surgical intervention were measured. We also measured the average times from hospital admission to surgery and compared these times across trauma centers, grouped level I, II, and III-V.
From 2004 to 2014, there were approximately 176,000 encounters meeting WSTR inclusion criteria. Approximately 60% of these trauma encounters included exposure to operative anesthesia during the admission. Among all surgical procedures during the trauma admission, approximately 33% occurred within a level I trauma center, 23% occurred within a level II trauma center, and 44% occurred in a trauma center with a III, IV, or V designation. The predominant procedure category during a trauma admission was orthopedic. The presence of hypotension on admission (P < .01), increasing injury severity score (P < .01) and higher emergency department Glasgow Coma Score (P < .01) were all associated with surgical intervention during the trauma hospitalization, after adjustment for potential confounders. In level I trauma centers, for general surgical procedures, the median time to surgery was 2.5 hours; in level II trauma centers, the median time was 1.7 hours.
This study highlights the frequent role anesthesiologists play in caring for patients who sustain traumatic injuries, in trauma centers levels I-V. In level II trauma centers, in-house anesthesiology coverage might have benefit for those patients requiring surgery within 1 hour, whereas the former American College of Surgeons requirement of 30-minute response time for out-of-hospital anesthesiology coverage is likely sufficient to provide satisfactory care to patients requiring surgery within 3 hours. Whether the increased cost of such in-house anesthesiology coverage at level II trauma centers is justified by its clinical benefit remains an unanswered question.
几乎所有的麻醉医师都会照顾遭受创伤的患者；然而，为这一特定患者群体提供手术麻醉服务的频率尚不清楚。我们希望通过使用来自华盛顿州创伤登记处（WSTR）这一全面的区域性数据库的数据，更好地了解麻醉提供者参与手术创伤治疗的程度，以及这种程度如何因创伤中心的指定级别（I-V 级）而有所不同。我们还试图根据美国外科医师学会（ACS）关于 II 级创伤中心认证的连续麻醉覆盖指南，专门评估手术麻醉服务的频率。
我们进行了一项回顾性分析，衡量了 WSTR 注册患者手术期间接受麻醉的频率。对接受手术治疗的创伤患者与仅接受医疗管理的患者（即仅接受手术治疗的患者）进行了单变量比较。此外，还测量了与手术干预相关的临床因素。我们还测量了从入院到手术的平均时间，并比较了不同创伤中心的这些时间，分为 I 级、II 级和 III-V 级。
2004 年至 2014 年期间，WSTR 纳入了约 176000 例符合条件的就诊。在这些创伤就诊中，约有 60%的患者在住院期间接受了手术麻醉。在所有创伤住院期间的手术中，约 33%发生在 I 级创伤中心，23%发生在 II 级创伤中心，44%发生在 III、IV 或 V 级创伤中心。创伤住院期间的主要手术类别是骨科。入院时出现低血压（P<.01）、损伤严重程度评分增加（P<.01）和急诊室格拉斯哥昏迷评分升高（P<.01），在调整了潜在混杂因素后，均与创伤住院期间的手术干预相关。在 I 级创伤中心，对于普通外科手术，手术的中位数时间为 2.5 小时；在 II 级创伤中心，中位数时间为 1.7 小时。
本研究强调了麻醉医师在 I-V 级创伤中心照顾遭受创伤的患者时经常发挥的重要作用。在 II 级创伤中心，内部麻醉科覆盖可能对那些需要在 1 小时内手术的患者有益，而以前美国外科医师学会要求的 30 分钟内对院外麻醉科的响应时间可能足以满足需要在 3 小时内手术的患者的满意护理。在 II 级创伤中心，内部麻醉科覆盖的增加成本是否因其临床益处而得到合理补偿，仍是一个未解决的问题。
