Otsuka Hiroyuki, Sato Toshiki, Sakurai Keiji, Aoki Hiromichi, Yamagiwa Takeshi, Iizuka Shinichi, Inokuchi Sadaki
Department of Emergency and Critical Care Medicine Tokai University School of Medicine Kanagawa Japan.
Acute Med Surg. 2018 Jul 15;5(4):342-349. doi: 10.1002/ams2.359. eCollection 2018 Oct.
Despite recent advancements in trauma management following introduction of interventional radiology (IVR) and damage-control strategies, challenges remain regarding optimal use of resources for severe trauma.
In October 2014, we implemented a trauma management system comprising emergency physicians competent in severe trauma management, surgical techniques, and IVR. To evaluate this system, of 5,899 trauma patients admitted to our hospital from January 2011 to January 2018, we selected 107 patients with severe trauma (injury severity score ≥ 16) who presented with persistent hypotension (two or more systolic blood pressure measurements <90 mmHg), regardless of primary resuscitation. Patients were divided according to the date of admission: Conventional (January 2011-September 2014) or Current (October 2014-January 2018). The primary end-point was in-hospital mortality. Secondary end-points included time from arrival to start of surgery/IVR.
There were 59 patients in the Conventional group and 48 in the Current group. Although patients in the Current group were more severely ill compared with those in the Conventional group, mortality in the Current group was significantly lower (Conventional 64.4% versus Current 41.7%, = 0.019), especially among patients whose first intervention was IVR (Conventional 75.0% versus Current 28.6%, = 0.001). Time from arrival to initiation of surgery/IVR was shorter in the Current group (Conventional 71.5 [53.8-130.8] min versus Current 41.0 [26.0-58.5] min, < 0.0001).
This trauma management system based on emergency physicians competent not only in severe trauma management, but also surgical techniques and IVR, could improve outcomes in patients with severe multiple lethal trauma.
尽管在引入介入放射学（IVR）和损伤控制策略后创伤管理方面取得了最新进展，但在严重创伤资源的最佳利用方面仍存在挑战。
2014年10月，我们实施了一个创伤管理系统，该系统由精通严重创伤管理、手术技术和IVR的急诊医生组成。为了评估该系统，在2011年1月至2018年1月期间入住我院的5899例创伤患者中，我们选择了107例严重创伤患者（损伤严重度评分≥16），这些患者出现持续性低血压（两次或更多次收缩压测量<90 mmHg），无论初始复苏情况如何。根据入院日期将患者分为：传统组（2011年1月至2014年9月）或当前组（2014年10月至2018年1月）。主要终点是住院死亡率。次要终点包括从到达至开始手术/IVR的时间。
传统组有59例患者，当前组有48例患者。尽管当前组患者与传统组患者相比病情更严重，但当前组的死亡率显著更低（传统组64.4% vs 当前组41.7%，P = 0.019），尤其是首次干预为IVR的患者（传统组75.0% vs 当前组28.6%，P = 0.001）。当前组从到达至开始手术/IVR的时间更短（传统组71.5 [53.8 - 130.8]分钟 vs 当前组41.0 [26.0 - 58.5]分钟，P < 0.0001）。
这种基于不仅精通严重创伤管理，还精通手术技术和IVR的急诊医生的创伤管理系统，可以改善严重多发致命伤患者的预后。
