Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, Japan.
Department of General Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan; Department of Health Services Research, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Japan.
Am J Emerg Med. 2019 Sep;37(9):1605-1610. doi: 10.1016/j.ajem.2018.11.014. Epub 2018 Nov 9.
The beneficial effect of the presence of an emergency physician in prehospital major trauma care is controversial. The aim in this study is to assess whether an emergency physician on scene can improve survival outcome of critical trauma patients.
This retrospective cohort study was conducted by using nationwide trauma registry data between 2004 and 2013 in Japan. Severe trauma patients (injury severity score (ISS) ≥ 16) who were transported directly to the hospital from the injury site were included in our analysis. Patients who were predicted to be untreatable (abbreviated injury score (AIS) = 6 and/or cardiopulmonary arrest at least one time before hospital arrival) were excluded. Participants were divided into either a physician or paramedics group based on the prehospital practitioner. The primary outcome was survival rate at discharge. Multivariable logistic regression analysis was performed to compare the outcome with adjustment for age, gender, ISS, cause of injury, and pre-hospital vital signs.
A total of 30,283 patients were eligible for the selection criteria (physician: 1222, paramedics: 29,061). Overall, 172 patients (14.1%) died in the physician group compared to 3508 patients (12.1%) in the paramedics group. Patients in the physician group had higher ISSs than those in the paramedics group. In multivariable logistic regression, the physician group had an odds ratio (OR) of 1.16 (95% confidence interval (CI) = 0.97 to 1.40, p = 0.11) for in-hospital survival.
Our results failed to show a difference in survival at discharge between non-physician-staffed ambulances and physician-staffed ambulances.
急诊医师在院前重大创伤救护中的有益作用存在争议。本研究旨在评估现场的急诊医师是否能提高危重伤患者的生存结果。
这是一项回顾性队列研究，使用了 2004 年至 2013 年日本全国创伤登记数据。严重创伤患者（损伤严重程度评分（ISS）≥16）从受伤现场直接被送往医院，被纳入本分析。预测无法治疗的患者（简明损伤评分（AIS）=6 且/或至少在到达医院前一次心跳骤停）被排除在外。根据院前医务人员，将患者分为医师组或急救员组。主要结局为出院时的生存率。采用多变量逻辑回归分析，对调整年龄、性别、ISS、损伤原因和院前生命体征后进行比较。
共有 30283 名患者符合入选标准（医师：1222 名，急救员：29 名，29061 名）。总体而言，医师组有 172 名（14.1%）患者死亡，急救员组有 3508 名（12.1%）患者死亡。医师组的 ISS 高于急救员组。多变量逻辑回归分析显示，医师组的院内生存率比值比（OR）为 1.16（95%置信区间（CI）=0.97 至 1.40，p=0.11）。
我们的结果未能显示非医师配备的救护车和医师配备的救护车在出院时的生存率存在差异。
