Nik Azlan N M, Ong S F
Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Emergency Medicine, Kuala Lumpur, Malaysia.
Med J Malaysia. 2019 Apr;74(2):116-120.
This study evaluates factors that influence door to operation theatre (OT) time in a tertiary referral centre following activation of trauma team. Specific factors observed in this study were association of the injury severity score (ISS), activation of trauma team and the number of referred specialty to door to operation theatre time.
Retrospective chart review that evaluates all trauma patients which required immediate operative intervention from January 2011 to December 2015. Trauma patients were selected from the resuscitation log book and data were collected by chart review of selected patients.
Only 5 out of 279 patients (1.8%) achieved optimal door to OT time. (<60 minutes) Mean door to OT time was 299.27 minutes (95% CI: 280.52, 318.52). Trauma team activation has shown significant improvement in door to OT time (p=0.047). Time of multiple team referrals (p=0.023) and time of operative decision (p<0.001) both had significant impact on door to OT time. Other factors included were demographics, ISS score, Glasgow Coma Scale (GCS), mechanism of injury and systolic blood pressure on arrival all which showed no significance.
Trauma team activation in a tertiary centre improved trauma care by reducing door to OT time to less than 60 minutes. Implementation of an effective trauma team activation system in all hospitals throughout Malaysia is recommended.
本研究评估了在三级转诊中心创伤团队启动后影响从入院到进入手术室（OT）时间的因素。本研究观察到的具体因素包括损伤严重程度评分（ISS）、创伤团队的启动以及从入院到进入手术室时间内被转诊专科的数量。
回顾性病历审查，评估2011年1月至2015年12月期间所有需要立即进行手术干预的创伤患者。从复苏日志中选取创伤患者，并通过对选定患者的病历审查收集数据。
279例患者中只有5例（1.8%）达到了最佳的从入院到进入手术室时间（<60分钟）。从入院到进入手术室的平均时间为299.27分钟（95%置信区间：280.52, 318.52）。创伤团队的启动在从入院到进入手术室时间方面显示出显著改善（p = 0.047）。多个团队转诊时间（p = 0.023）和手术决策时间（p < 0.001）对从入院到进入手术室时间均有显著影响。其他包括的因素有人口统计学、ISS评分、格拉斯哥昏迷量表（GCS）、损伤机制和入院时的收缩压，所有这些均无显著性。
三级中心的创伤团队启动通过将从入院到进入手术室时间缩短至60分钟以内改善了创伤护理。建议在马来西亚所有医院实施有效的创伤团队启动系统。
