Barts and The London School of Anaesthesia, Barts Health NHS Trust, London, UK.
Trauma Research and Audit Network, University of Manchester, Salford, UK.
BJS Open. 2020 Oct;4(5):963-969. doi: 10.1002/bjs5.50316. Epub 2020 Jul 9.
Significant mortality improvements have been reported following the implementation of English trauma networks. Timely transfer of seriously injured patients to definitive care is a key indicator of trauma network performance. This study evaluated timelines from emergency service (EMS) activation to definitive care between 2013 and 2016.
An observational study was conducted on data collected from the UK national clinical audit of major trauma care of patients with an Injury Severity Score above 15. Outcomes included time from EMS activation to: arrival at a trauma unit (TU) or major trauma centre (MTC); to CT; to urgent surgery; and to death.
Secondary transfer was associated with increased time to urgent surgery (median 7·23 (i.q.r. 5·48-9·28) h versus 4·37 (3·00-6·57) h for direct transfer to MTC; P < 0·001) and an increased crude mortality rate (19·6 (95 per cent c.i. 16·9 to 22·3) versus 15·7 (14·7 to 16·7) per cent respectively). CT and urgent surgery were performed more quickly in MTCs than in TUs (2·00 (i.q.r. 1·55-2·73) versus 3·15 (2·17-4·63) h and 4·37 (3·00-6·57) versus 5·37 (3·50-7·65) h respectively; P < 0·001). Transfer time and time to CT increased between 2013 and 2016 (P < 0·001). Transfer time, time to CT, and time to urgent surgery varied significantly between regional networks (P < 0·001).
Secondary transfer was associated with significantly delayed imaging, delayed surgery, and increased mortality. Key interventions were performed more quickly in MTCs than in TUs.
实施英语创伤网络后，报告了显著的死亡率改善。将重伤患者及时转至确定性治疗是创伤网络性能的关键指标。本研究评估了 2013 年至 2016 年间从紧急服务（EMS）激活到确定性治疗的时间线。
对来自英国重大创伤护理国家临床审计中损伤严重度评分超过 15 分的患者数据进行观察性研究。结局包括从 EMS 激活到：到达创伤单位（TU）或主要创伤中心（MTC）；进行 CT；进行紧急手术；以及死亡的时间。
二次转院与紧急手术时间延长相关（中位数 7.23（IQR 5.48-9.28）h 与直接转至 MTC 的 4.37（3.00-6.57）h；P<0.001），且粗死亡率增加（19.6（95%可信区间 16.9 至 22.3）%与分别为 15.7（14.7 至 16.7）%）。MTC 中 CT 和紧急手术进行得更快（2.00（IQR 1.55-2.73）h 与 3.15（2.17-4.63）h 和 4.37（3.00-6.57）h 与 5.37（3.50-7.65）h；P<0.001）。2013 年至 2016 年期间，转院时间和 CT 时间增加（P<0.001）。转院时间、CT 时间和紧急手术时间在不同区域网络之间差异显著（P<0.001）。
二次转院与影像学延迟、手术延迟和死亡率增加显著相关。关键干预措施在 MTC 中比在 TU 中进行得更快。
