成人患者转诊至坦桑尼亚一家三级转诊医院的城市急诊科前的转院前稳定和符合世卫组织创伤护理指南的情况。
Pre-referral stabilization and compliance with WHO guidelines for trauma care among adult patients referred to an urban emergency department of a tertiary referral hospital in Tanzania.
机构信息
Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
出版信息
BMC Emerg Med. 2019 Feb 28;19(1):22. doi: 10.1186/s12873-019-0237-2.
BACKGROUND
The outcomes of trauma are considered to be time dependent. Efficient and timely pre-referral stabilization of trauma patients has been shown to impact survival. Tanzania has no formal pre-hospital or trauma system. World Health Organisation has provided a set of standards for initial stabilization of trauma patients according to the level of the hospitals. We aimed to describe pre-referral stabilization provided to adult trauma patient referred to the national referral hospital and compliance with World Health Organisation guidelines.
METHODS
This prospective observational cross-sectional study was conducted at the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH), between July 2017 and December 2017. Eligible patients were adults with head injury and extremity injury ≥18 years who were referred from a peripheral hospital and had a referral note. Research assistant enrolled patients using structured case report form clinical information, and initial stabilization received at the referring hospital. Primary outcome was the proportion of patients who had initial stabilization performed according to World Health Organisation recommendation.
RESULTS
We enrolled 368 (29% of eligible patients), the median age was 34 years (Interquartile range 26-44 years), and 281 (76%) were male. Overall 69% of referred patients arrived at the EMD more than 24 h after injury. Of those enrolled, 50 (13.6%) patients had received at least one stabilization intervention prior to transfer to MNH. Among 206 patients with extremity injuries, splinting was inadequate or missing in all cases; No patients with head injury received cervical spine protection. Among patients referred from a health center, 26.9% received an initial stabilization, while stabilization procedures were administered to 13.2% of those from district hospitals, and 10% of those from regional hospitals.
CONCLUSIONS
In this urban public emergency department in Tanzania, majority of trauma patients were referred from lower health facilities after 24-h of injury. Most did not receive initial trauma stabilization as recommended by the World Health Organisation guidelines. Future studies should identify barriers to pre-referral stabilization of adult trauma patients.
背景
创伤的结果被认为是与时间相关的。已经证明，对创伤患者进行高效和及时的转诊前稳定化处理会影响其生存率。坦桑尼亚没有正式的院前或创伤系统。世界卫生组织根据医院的级别为创伤患者的初步稳定化提供了一套标准。我们旨在描述转诊到国家转诊医院的成年创伤患者接受的转诊前稳定化处理，并评估其是否符合世界卫生组织的指导方针。
方法
这项前瞻性观察性横断面研究于 2017 年 7 月至 12 月在穆希比利国家医院（MNH）的急诊医学部（EMD-MNH）进行。合格的患者为年龄≥18 岁的头部和四肢受伤并从外围医院转诊且附有转诊单的成年人。研究助理使用结构化病例报告表记录患者的临床信息和在转诊医院接受的初步稳定化处理。主要结局是根据世界卫生组织的建议进行初始稳定化处理的患者比例。
结果
我们共纳入 368 例（合格患者的 29%），中位年龄为 34 岁（四分位间距 26-44 岁），281 例（76%）为男性。总体而言，69%的转诊患者在受伤后 24 小时以上到达 EMD。在纳入的患者中，50 例（13.6%）患者在转诊到 MNH 之前至少接受过一次稳定化干预。在 206 例四肢受伤患者中，所有患者的固定都不充分或缺失；没有头部受伤的患者接受过颈椎保护。在从卫生中心转诊的患者中，有 26.9%接受了初步稳定化处理，而在从地区医院转诊的患者中，有 13.2%接受了稳定化处理，在从地区医院转诊的患者中，有 10%接受了稳定化处理。
结论
在坦桑尼亚这个城市的公立急诊部，大多数创伤患者在受伤后 24 小时从较低级别的医疗机构转诊而来。大多数患者未接受世界卫生组织指南推荐的初步创伤稳定化处理。未来的研究应确定阻碍成年创伤患者转诊前稳定化处理的因素。
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