Carvajal Sandra, Uribe-Buritica Francisco L, Ángel-Isaza Ana Maria, López-Girón María Camila, González Andres, Chica Julian, Benitez Manuel, García Alberto F
Fundación Valle del Lili, Emergency Department, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia.
Clinical Research Center, Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia.
Int J Emerg Med. 2020 Jul 14;13(1):36. doi: 10.1186/s12245-020-00297-7.
Trauma teams (TTs) improve outcomes in trauma patients. A multidisciplinary TT was conformed in September 2015 in a tertiary level I trauma university hospital in southwestern Colombia, a middle-income war-influenced country.
To evaluate the impact of a TT in admission-tomography and admission-surgery times as well as mortality in a tertiary center university hospital in a middle-income country war-influenced country.
Retrospective analytical study. Patients older than 17 years admitted to the emergency room 15 months prior and 15 months after the TT implementation were included. Patients prior to the TT implementation were taken as controls. No exclusion criteria. Four hundred sixty-four patients were included, 220 before the TT implementation (BTT) and 244 after (ATT). Demographic data, trauma characteristics, admission-tomography, and admission-surgery time interval as well as mortality were recorded. Requirement of CT scan or surgery was based on physician decision. The analysis was made on Stata 15.1®. Categorical variables were described as quantities and proportions, and continuous variables as mean and standard deviation or median and interquartile range (IQR). Categorical variables were compared using χ or Fisher's test and continuous variables using Student's T test or Wilcoxon-Mann-Whitney. A multiple logistic regression model was created to evaluate the impact of being treated in the ATT group on mortality, adjusted by age, trauma severity, and physiological response upon admission.
The admission-tomography time interval was 56 min (IQR 39-100) in the BTT group and 40 min (IQR 24-76) in the ATT group, p < 0.001. The admission-surgery time interval was 116 min (IQR 63-214) in the BTT group and 52 min (IQR 24-76) in the ATT group, p < 0.001. Mortality in the BTT group was 18.1% and 13.1% in the ATT group. Adjusted OR was 0.406 (0.215-0.789) p = 0.006 CONCLUSIONS: A trauma team conformation in a war-influenced middle-income country is feasible and reduces mortality as well as admission-surgery and admission-tomography time intervals in trauma patients.
创伤团队（TTs）可改善创伤患者的治疗效果。2015年9月，在哥伦比亚西南部一所受战争影响的中等收入国家的一级创伤大学附属医院组建了一个多学科创伤团队。
评估创伤团队对中等收入受战争影响国家的三级中心大学医院中创伤患者的入院至断层扫描时间、入院至手术时间以及死亡率的影响。
回顾性分析研究。纳入在创伤团队实施前15个月和实施后15个月入住急诊室的17岁以上患者。将创伤团队实施前的患者作为对照组。无排除标准。共纳入464例患者，创伤团队实施前（BTT）220例，实施后（ATT）244例。记录人口统计学数据、创伤特征、入院至断层扫描时间、入院至手术时间间隔以及死亡率。CT扫描或手术的需求由医生决定。分析使用Stata 15.1®软件进行。分类变量以数量和比例描述，连续变量以均值和标准差或中位数和四分位间距（IQR）描述。分类变量使用χ²检验或Fisher检验进行比较，连续变量使用Student's T检验或Wilcoxon-Mann-Whitney检验进行比较。建立多元逻辑回归模型以评估在ATT组接受治疗对死亡率的影响，并根据年龄、创伤严重程度和入院时的生理反应进行调整。
BTT组的入院至断层扫描时间间隔为56分钟（IQR 39 - 100），ATT组为40分钟（IQR 24 - 76），p < 0.001。BTT组的入院至手术时间间隔为116分钟（IQR 63 - 214），ATT组为52分钟（IQR 24 - 76），p < 0.001。BTT组的死亡率为18.1%，ATT组为13.1%。调整后的OR为0.406（0.215 - 0.789），p = 0.006。结论：在受战争影响的中等收入国家组建创伤团队是可行的，可降低创伤患者的死亡率以及入院至手术和入院至断层扫描的时间间隔。
