简化创伤管理方法对血流动力学不稳定的严重多发伤患者死亡率的影响及死亡决定因素：一项前后对照的回顾性队列研究
Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study.
作者信息
Otsuka Hiroyuki, Uehata Atsushi, Sakoda Naoki, Sato Toshiki, Sakurai Keiji, Aoki Hiromichi, Yamagiwa Takeshi, Iizuka Shinichi, Inokuchi Sadaki
机构信息
Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan.
出版信息
Trauma Surg Acute Care Open. 2020 Sep 25;5(1):e000534. doi: 10.1136/tsaco-2020-000534. eCollection 2020.
BACKGROUND
Trauma management requires a multidisciplinary approach, but coordination of staff and procedures is challenging in patients with severe trauma. In October 2014, we implemented a streamlined trauma management system involving emergency physicians trained in severe trauma management, surgical techniques, and interventional radiology. We evaluated the impact of streamlined trauma management on patient management and outcomes (study 1) and evaluated determinants of mortality in patients with severe trauma (study 2).
METHODS
We conducted a retrospective cohort study of 125 patients admitted between January 2011 and 2019 with severe trauma (Injury Severity Score ≥16) and persistent hypotension (≥2 systolic blood pressure measurements <90 mm Hg). Patients were divided into a Before cohort (January 2011 to September 2014) and an After cohort (October 2014 to January 2019) according to whether they were admitted before or after the new approach was implemented. The primary outcome was in-hospital mortality.
RESULTS
Compared with the Before cohort (n=59), the After cohort (n=66) had a significantly lower in-hospital mortality (36.4% vs. 64.4%); required less time from hospital arrival to initiation of surgery/interventional radiology (median, 41.0 vs. 71.5 minutes); and was more likely to undergo resuscitative endovascular balloon occlusion of the aorta (24.2% vs. 6.8%). Plasma administration before initiating hemostasis (adjusted OR 1.49 (95% CI 1.04 to 2.14)), resuscitative endovascular balloon occlusion of the aorta (9.48 (95% CI 1.25 to 71.96)), and shorter time to initiation of surgery/interventional radiology (0.97 (95% CI 0.96 to 0.99)) were associated with significantly lower mortality.
DISCUSSION
Implementing a streamlined trauma management protocol improved outcomes among hemodynamically unstable patients with severe multiple trauma.
LEVEL OF EVIDENCE
Level III.
背景
创伤管理需要多学科方法，但在严重创伤患者中，工作人员和程序的协调具有挑战性。2014年10月，我们实施了一种简化的创伤管理系统，涉及接受过严重创伤管理、外科技术和介入放射学培训的急诊医生。我们评估了简化创伤管理对患者管理和结局的影响（研究1），并评估了严重创伤患者死亡率的决定因素（研究2）。
方法
我们对2011年1月至2019年期间收治的125例严重创伤（损伤严重度评分≥16）且持续低血压（收缩压≥2次测量<90 mmHg）的患者进行了一项回顾性队列研究。根据患者在新方法实施之前或之后入院，将其分为前队列（2011年1月至2014年9月）和后队列（2014年10月至2019年1月）。主要结局是住院死亡率。
结果
与前队列（n = 59）相比，后队列（n = 66）的住院死亡率显著降低（36.4%对64.4%）；从入院到开始手术/介入放射学所需时间更短（中位数，41.0对71.5分钟）；接受主动脉复苏性血管内球囊阻断术的可能性更高（24.2%对6.8%）。止血前输注血浆（校正比值比1.49（95%可信区间1.04至2.14））、主动脉复苏性血管内球囊阻断术（9.48（95%可信区间1.25至71.96））以及更短的开始手术/介入放射学时间（0.97（95%可信区间0.96至0.99））与显著降低的死亡率相关。
讨论
实施简化的创伤管理方案可改善血流动力学不稳定的严重多发伤患者的结局。
证据级别
三级。
Zotero 插件