与新斯科舍省创伤患者器官捐献相关的因素。

Factors associated with organ donation by trauma patients in Nova Scotia.

机构信息

From the Dalhousie University Medical School (A.H., A.C., S.L.), Halifax, NS, Canada; Nova Scotia Department of Health and Wellness (M.E., R.S.G.), Trauma Nova Scotia, Halifax, NS, Canada; Department of Critical Care (S.D.B., R.S.G.), Dalhousie University, Halifax, NS, Canada; Department of Anesthesia, Pain Management & Perioperative Medicine (S.D.B.), Dalhousie University, Halifax, NS, Canada; Department of Emergency Medicine (R.S.G.), Dalhousie University, Halifax, NS, Canada; and Department of Surgery (R.S.G.), Dalhousie University, Halifax, NS, Canada.

出版信息

J Trauma Acute Care Surg. 2020 Jan;88(1):128-133. doi: 10.1097/TA.0000000000002500.

DOI:10.1097/TA.0000000000002500

PMID:31469770

Abstract

BACKGROUND

Trauma patients represent a significant pool of potential organ donors (PODs), and previous research suggests that this population is underutilized for organ donation (OD). Our objective was to assess factors associated with OD in the trauma population.

METHODS

We retrospectively analyzed OD in Nova Scotia over a 7-year period (2009-2016) using data from the Nova Scotia Trauma Registry and Nova Scotia Legacy of Life Donor Registry. All trauma patients who died in the hospital were included. Multiple logistic regression was used to assess factors associated with donation. We also evaluated characteristics, donation types, and reasons for nondonation among trauma PODs.

RESULTS

There were 689 trauma-related deaths in all hospitals in NS during the study period, of which 39.8% (274 of 689) met the Nova Scotia Trauma Registry definition of a POD. Data on OD were available for 108 of these patients who were referred to the Legacy of Life Program. The conversion rate was 84%. Compared with nondonors, organ donors were significantly younger, had a higher Abbreviated Injury Scale head score and a lower scene Glasgow Coma Scale score, were more likely to suffer ischemia from drowning or asphyxia and to require air transport, and were less likely to have comorbidities. Regression analysis showed that donation was associated with younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-0.99) and lower Glasgow Coma Scale score at the scene (OR, 0.76; 95% CI, 0.66-0.88). Odds of donation were increased with air transport compared with land ambulance (OR, 8.27; 95% CI, 2.07-33.08) and injury within Halifax Regional Municipality compared with injury outside Halifax Regional Municipality (OR, 4.64; 95% CI, 1.42-15.10). Among the 60 referred PODs who did not donate, family refusal of consent was the most common reason (28 [46.7%] of 60).

CONCLUSION

Younger age, greater severity of injury, and shorter time to tertiary care were associated with OD in trauma patients.

LEVEL OF EVIDENCE

Prognostic and Epidemiological, Level III.

摘要

背景

创伤患者是潜在器官捐献者（POD）的重要来源，但先前的研究表明，这一人群在器官捐献（OD）方面的利用率较低。我们的目的是评估与创伤人群 OD 相关的因素。

方法

我们使用 Nova Scotia 创伤登记处和 Nova Scotia 生命遗产捐献登记处的数据，对 7 年期间（2009-2016 年） Nova Scotia 的 OD 情况进行回顾性分析。纳入所有在医院死亡的创伤患者。采用多因素逻辑回归分析评估与捐献相关的因素。我们还评估了创伤 POD 的特征、捐献类型和非捐献原因。

结果

研究期间，所有医院共有 689 例与创伤相关的死亡，其中 39.8%（274/689）符合 Nova Scotia 创伤登记处 POD 定义。有 108 名患者的 OD 数据可用于 Legacy of Life 计划，这些患者均来自上述创伤患者。转化率为 84%。与非捐献者相比，器官捐献者明显更年轻，头部损伤严重程度评分（Abbreviated Injury Scale）较高，现场格拉斯哥昏迷评分（Glasgow Coma Scale）较低，更有可能因溺水或窒息导致缺血，需要空运，且合并症较少。回归分析显示，OD 与年龄较小（比值比[OR]，0.97；95%置信区间[CI]，0.95-0.99）和现场格拉斯哥昏迷评分较低（OR，0.76；95%CI，0.66-0.88）相关。与陆地救护车相比，空运（OR，8.27；95%CI，2.07-33.08）和 Halifax 地区以外的损伤（OR，4.64；95%CI，1.42-15.10）与 OD 几率增加有关。在 60 名被转介的 POD 中，有 28 名（60%）家属拒绝同意捐献。