Soni Kapil Dev, Mahindrakar Santosh, Kaushik Gaurav, Kumar Subodh, Sagar Sushma, Gupta Amit
Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
J Emerg Trauma Shock. 2019 Apr-Jun;12(2):128-134. doi: 10.4103/JETS.JETS_76_18.
Trauma systems vary in performance during different time periods and may affect the patient outcomes, especially in resource-limited settings. The present study was undertaken to study the pattern, epidemiological profile, processes of care variations of trauma victims presenting during-hours and after-hours in a level 1 trauma Center of a lower middle-income country.
Retrospective analyses of prospectively collected data registry at a single tertiary care center. Data collected from 2013 to 2015 were analyzed. Patients with a history of trauma and admission to the center or death between arrival and admission were included. Isolated limb injury and patients dead on arrival were excluded.
Of 4692, 1789 (38.1%) patients arrived and were admitted during-hours and 2903 (61.9%) after-hours. The overall in-hospital mortality was 14.9% in the cohort. Moreover, it was 16.10% during after-hours in comparison to 13.0% during-hours. The Revised Trauma Score was statistically different during-hours and after-hours suggesting patients with greater physiological derangement after-hours. The Kaplan-Meier survival curves for 7 days were comparable in two groups with the log-rank test of 078. The proportion of initial radiological investigations (chest X-ray, focused assessment sonography in trauma [FAST], and computerized tomography [CT] scans) was ranged from 84.9% for CT scans in the cohort to 99.3% for FAST.
Processes of care do not differ significantly for the patients admitted at a level 1 trauma center irrespective of time of the day. Although survival probability for the initial 7 days of follow-up is comparable between two groups; however, for 30 and 90 days of follow-up they are significantly different between during-hours and after-hours, likely due to injury severity.
创伤系统在不同时间段的表现各异，可能会影响患者的治疗结果，尤其是在资源有限的环境中。本研究旨在探讨一个中低收入国家一级创伤中心白天和夜间创伤患者的模式、流行病学特征以及护理过程的差异。
对一家三级护理中心前瞻性收集的数据登记册进行回顾性分析。分析了2013年至2015年收集的数据。纳入有创伤史且入院或在到达后至入院期间死亡的患者。排除孤立肢体损伤和到达时死亡的患者。
在4692例患者中，1789例（38.1%）在白天到达并入院，2903例（61.9%）在夜间到达并入院。该队列的总体院内死亡率为14.9%。此外，夜间死亡率为16.10%，而白天为13.0%。修订创伤评分在白天和夜间有统计学差异，表明夜间患者的生理紊乱更严重。两组7天的Kaplan-Meier生存曲线具有可比性，对数秩检验为0.78。初始影像学检查（胸部X线、创伤重点超声检查[FAST]和计算机断层扫描[CT]）的比例范围为队列中CT扫描的84.9%至FAST的99.3%。
无论一天中的什么时间，一级创伤中心收治的患者护理过程没有显著差异。虽然两组在随访的最初7天生存概率具有可比性；然而，在随访30天和90天时，白天和夜间之间存在显著差异，可能是由于损伤严重程度不同。
