Advanced Clinical Simulation Center, School of Medicine, Universidad de Valladolid. Avda. Ramón y Cajal, 7. 47005, Valladolid. Spain.
Advanced Clinical Simulation Center, School of Medicine, Universidad de Valladolid. Advanced Life Support Unit, Emergency Medical Services, Valladolid. Avda. Ramón y Cajal, 7. 47005, Valladolid. Spain.
Injury. 2020 Jul;51(7):1554-1560. doi: 10.1016/j.injury.2020.04.042. Epub 2020 May 16.
Traumatically injured patients are at higher risk of serious adverse events. Numerous physiological scoring systems are employed as diagnostic and/or prognostic tools. The objective of this study was to evaluate the scales most commonly used by emergency medical services for the early detection of prehospital serious adverse events.
Design. Preliminary longitudinal prospective observational study without intervention study in adults with prehospital traumatic injury.
The study was carried out in the public health system of Castile and León (Spain), from April 1, 2018 to October 31, 2019, involving seven advanced life support units and five hospitals.
Traumatically injured patients over 18 years of age who were stabilized and transferred in advanced life support units to their referral hospital.
Appearance of serious adverse events at the prehospital level at the scene or during the transfer to the emergency department.
A total of 346 patients were included in the study. The median age was 50 years (IQR: 38-65). 32 cases (7.8%) presented serious adverse events at the prehospital level. Areas under the curve for the detection of serious adverse events were obtained with the Prehospital Index (0.979; 95% CI: 0.94-1.00) and National Early Warning Score 2 (0.956; 95% CI: 0.90-1.00); p <0.001 for all scores. The Prehospital Index had a positive probability coefficient of 78.4 (95% CI: 62.8-68.6) and the National Early Warning Score 2 obtained 52.9 (95% CI: 39.7-65.6). A comparison of the curves was not significant for any of the scores studied (p> 0.05).
All scoring systems were able to detect prehospital serious adverse events early in traumatic injury; therefore, any of the scoring systems could be useful and represent an ideal tool for routine use by emergency medical services in cases of traumatic injury.
创伤患者发生严重不良事件的风险较高。有许多生理评分系统被用作诊断和/或预后工具。本研究的目的是评估急救医疗服务机构（EMS）早期检测创伤患者院前严重不良事件最常使用的评分系统。
设计：初步纵向前瞻性观察研究，不进行干预研究，对象为院前创伤的成年患者。
该研究于 2018 年 4 月 1 日至 2019 年 10 月 31 日在西班牙卡斯蒂利亚-莱昂的公共卫生系统中进行，涉及 7 个高级生命支持单位和 5 家医院。
年龄超过 18 岁的创伤患者，在高级生命支持单位稳定后被转移至转诊医院。
在现场或在向急诊部转移过程中出现院前严重不良事件。
共有 346 名患者纳入本研究。中位年龄为 50 岁（IQR：38-65）。32 例（7.8%）患者在院前发生严重不良事件。院前指数（0.979；95%CI：0.94-1.00）和国家早期预警评分 2（0.956；95%CI：0.90-1.00）检测严重不良事件的曲线下面积，所有评分均有显著差异（p<0.001）。院前指数的阳性概率系数为 78.4（95%CI：62.8-68.6），国家早期预警评分 2 为 52.9（95%CI：39.7-65.6）。对于研究的任何评分系统，曲线比较均无统计学意义（p>0.05）。
所有评分系统都能够早期检测创伤患者的院前严重不良事件，因此任何评分系统都可能有用，是创伤急救医疗服务机构常规使用的理想工具。
