全州创伤系统中失败救援事件的位置和时间。

The Location and Timing of Failure-to-Rescue Events Across a Statewide Trauma System.

机构信息

Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.

出版信息

J Surg Res. 2019 Mar;235:529-535. doi: 10.1016/j.jss.2018.10.017. Epub 2018 Nov 26.

DOI:10.1016/j.jss.2018.10.017

PMID:30691839

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6713902/

Abstract

BACKGROUND

Failure to rescue (FTR) refers to death after a major complication. Defining the optimal context in which to reduce FTR after injury requires knowledge of where and when FTR events occur.

MATERIALS AND METHODS

Retrospective observational study of patients >16 y with a minimum Abbreviated Injury Score ≥2 at all 30 level I and II Pennsylvania trauma centers (2007-2015). Location and timing of the first major complication were collected. Complication, mortality, and FTR rates were calculated by location (prehospital, emergency department, operating room, stepdown unit, interventional radiology, intensive care unit (ICU), radiology, and the surgical ward) and by postadmission day. Kruskal-Wallis and chi-squared tests were used to compare variables.

RESULTS

Major complications occurred in 15,388 of 178,602 (8.6%) patients. The median age was 58 y (interquartile range [IQR] 37-77 y), 78% were Caucasian, 68% were male, 89% were bluntly injured, and the median Injury Severity Score was 19 (IQR 10-29). Death occurred in 2512 of 15,388 patients with a major complication, for an FTR rate of 16.3%. Compared with non-FTR, FTR had earlier major complications (median day 2 [IQR 0-5 d] versus day 4 [IQR 2-8 d], P < 0.001). FTR rates were highest in the prehospital setting (42%), the operating room (33%), and the emergency department (32%), but the greatest number (1608 of 2512 total FTR events, 64%) occurred in the ICU. Pulmonary (32%) and cardiac (26%) complications most frequently contributed to FTR deaths.

CONCLUSIONS

Interventions designed to reduce FTR after injury should focus on pulmonary and cardiac complications in the ICU.

摘要

背景

失败复苏（FTR）是指重大并发症后死亡。要确定减少创伤后 FTR 的最佳环境，需要了解 FTR 事件发生的地点和时间。

材料和方法

对宾夕法尼亚州 30 个一级和二级创伤中心（2007-2015 年）所有≥16 岁、最低损伤严重程度评分（Abbreviated Injury Score）≥2 的患者进行回顾性观察性研究。收集首次重大并发症的位置和时间。根据位置（院前、急诊部、手术室、病房、介入放射科、重症监护病房（ICU）、放射科和外科病房）和入院后天数计算并发症、死亡率和 FTR 发生率。采用 Kruskal-Wallis 和卡方检验比较变量。

结果

178602 例患者中 15388 例（8.6%）发生重大并发症。患者的中位年龄为 58 岁（四分位间距[IQR] 37-77 岁），78%为白人，68%为男性，89%为钝性损伤，损伤严重程度评分中位数为 19（IQR 10-29）。15388 例发生重大并发症的患者中，2512 例死亡，FTR 率为 16.3%。与非 FTR 相比，FTR 发生更早的重大并发症（中位数为第 2 天[IQR 0-5 天]与第 4 天[IQR 2-8 天]，P<0.001）。FTR 发生率最高的是院前（42%）、手术室（33%）和急诊部（32%），但 ICU 中发生的病例最多（2512 例总 FTR 事件中的 1608 例，占 64%）。肺部（32%）和心脏（26%）并发症是导致 FTR 死亡的最常见原因。