From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar).
Can J Surg. 2019 Apr 1;62(2):123-130. doi: 10.1503/cjs.004218.
Trauma is a leading contributor to the burden of disease in Canada, accounting for more than 15 000 deaths annually. Although caring for injured patients at designated trauma centres (TCs) is consistently associated with survival benefits, it is unclear how travel time to definitive care influences outcomes. Using a population-based sample of trauma patients, we studied the association between predicted travel time (PTT) to TCs and mortality for patients assigned to ground transport.
Victims of penetrating trauma or motor vehicle collisions (MVCs) in Nova Scotia between 2005 and 2014 were identified from a provincial trauma registry. We conducted cost distance analyses to quantify PTT for each injury location to the nearest TC. Adjusted associations between TC access and injury-related mortality were then estimated using logistic regression.
Greater than 30 minutes of PTT to a TC was associated with a 66% increased risk of death for MVC victims (p = 0.045). This association was lost when scene deaths were excluded from the analysis. Sustaining a penetrating trauma greater than 30 minutes from a TC was associated with a 3.4-fold increase in risk of death. Following the exclusion of scene deaths, this association remained and approached significance (odds ratio 3.48, 95% confidence interval 0.98–14.5, p = 0.053).
Predicted travel times greater than 30 minutes were associated with worse outcomes for victims of MVCs and penetrating injuries. Improving communication across the trauma system and reducing prehospital times may help optimize outcomes for rural trauma patients.
在加拿大，创伤是导致疾病负担的主要原因之一，每年导致超过 15000 人死亡。尽管在指定的创伤中心（TC）照顾受伤患者与生存获益一致，但旅行时间对明确治疗的影响尚不清楚。本研究使用基于人群的创伤患者样本，研究了预测到 TC 的旅行时间（PTT）与被分配到地面运输的患者死亡率之间的关系。
2005 年至 2014 年，在新斯科舍省，从省级创伤登记处确定了穿透性创伤或机动车碰撞（MVC）的受害者。我们进行了成本距离分析，以量化每个受伤地点到最近 TC 的 PTT。然后使用逻辑回归估计 TC 获得与与伤害相关的死亡率之间的调整关联。
对于 MVC 受害者，超过 30 分钟的 TC PTT 与死亡风险增加 66%相关（p = 0.045）。当从分析中排除现场死亡时，这种关联就会消失。与 TC 保持 30 分钟以上的穿透性创伤与死亡风险增加 3.4 倍相关。在排除现场死亡后，这种关联仍然存在且接近显著（优势比 3.48，95%置信区间 0.98-14.5，p = 0.053）。
对于 MVC 和穿透性创伤受害者，预测的旅行时间超过 30 分钟与较差的结果相关。改善创伤系统内的沟通并减少院前时间可能有助于优化农村创伤患者的结局。
