卢旺达基加利创伤性脑损伤的初步院前管理。
The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda.
机构信息
Division of Acute Care Surgery, Department of Surgery Virginia Commonwealth University School of Medicine, Richmond, VirginiaUSA.
Service d'Aide Médicale d'Urgence-Rwanda Ministry of Health, Kigali, Rwanda.
出版信息
Prehosp Disaster Med. 2020 Oct;35(5):533-537. doi: 10.1017/S1049023X20000813. Epub 2020 Jun 30.
INTRODUCTION
Traumatic brain injuries (TBIs) are an important cause of mortality and disability around the world. Early intervention and stabilization are necessary to obtain optimal outcomes, yet little is written on the topic in low- and middle-income countries (LMICs). The aim is to provide a descriptive analysis of patients with TBI treated by Service d'Aide Medicale Urgente (SAMU), the prehospital ambulance service in Kigali, Rwanda.
HYPOTHESIS/PROBLEM: What is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda?
METHODS
A retrospective descriptive analysis was performed using SAMU records captured on an electronic database from December 2012 through May 2016. Variables included demographic information, injury characteristics, and interventional data.
RESULTS
Patients with TBIs accounted for 18.0% (n = 2,012) of all SAMU cases. The incidence of TBIs in Kigali was 234 crashes per 100,000 people. The mean age was 30.5 (SD = 11.5) years and 81.5% (n = 1,615) were men. The most common mechanisms were road traffic incidents (RTIs; 78.5%, n = 1,535), assault (10.7%, n=216), and falls (7.8%, n=156). Most patients experienced mild TBI (Glasgow Coma Score [GCS] ≥ 13; 83.5%, n = 1,625). The most common interventions were provision of pain medications (71.0%, n = 1,429), placement of a cervical collar (53.6%, n = 1,079), and administration of intravenous fluids (48.7%, n = 979). In total, TBIs were involved in 67.0% of all mortalities seen by SAMU.
CONCLUSION
Currently, TBIs represent a large burden of disease managed in the prehospital setting of Kigali, Rwanda. These injuries are most often caused by RTIs and were observed in 67% of mortalities seen by SAMU. Rwanda has implemented several initiatives to reduce the incidence of TBIs with a specific emphasis on road safety. Further efforts are needed to better prevent these injuries. Countries seeking to develop prehospital care capacity should train providers to manage patients with TBIs.
引言
创伤性脑损伤（TBI）是全球范围内导致死亡和残疾的一个重要原因。为了获得最佳的治疗效果，早期干预和稳定病情是必要的，但在中低收入国家（LMICs），这方面的研究却很少。本研究旨在对卢旺达基加利的急救医疗服务（SAMU）治疗的 TBI 患者进行描述性分析。
假设/问题：卢旺达基加利的救护车上 TBI 的发生率和性质如何？
方法
采用回顾性描述性分析方法，对 2012 年 12 月至 2016 年 5 月期间电子数据库中 SAMU 记录的患者进行分析。变量包括人口统计学信息、损伤特征和干预数据。
结果
TBI 患者占所有 SAMU 病例的 18.0%（n=2012）。基加利 TBI 的发生率为每 10 万人中有 234 例事故。患者的平均年龄为 30.5（SD=11.5）岁，81.5%（n=1615）为男性。最常见的机制是道路交通事件（78.5%，n=1535）、袭击（10.7%，n=216）和跌倒（7.8%，n=156）。大多数患者的损伤程度为轻度（格拉斯哥昏迷评分[GCS]≥13；83.5%，n=1625）。最常见的干预措施是提供止痛药物（71.0%，n=1429）、放置颈托（53.6%，n=1079）和静脉输液（48.7%，n=979）。总的来说，TBI 与 SAMU 所见的 67.0%的死亡有关。
结论
目前，TBI 是卢旺达基加利院前治疗的主要疾病负担。这些损伤主要由道路交通事件引起，在 SAMU 所见的死亡病例中占 67%。卢旺达已经实施了多项减少 TBI 发生率的倡议，特别是对道路安全的关注。需要进一步努力更好地预防这些损伤。寻求发展院前医疗服务能力的国家应培训提供者管理 TBI 患者。
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