From the Division of Trauma and Surgical Critical Care (Y.U., A.W., N.M., S.F.), Osaka General Medical Center, Osaka; Department of Traumatology and Acute Critical Medicine (T.K.), Graduate School of Medicine, Osaka University, Suita; and Department of Emergency Medicine (K.Y.), Osaka Medical College, Osaka, Japan.
J Trauma Acute Care Surg. 2021 Feb 1;90(2):232-239. doi: 10.1097/TA.0000000000003020.
The hybrid emergency room (ER) system is a novel trauma workflow that uses angio-computed tomography equipment in a trauma resuscitation room. Although the hybrid ER system decreases time to start surgery and endovascular treatments and improves mortality, the optimal target benefitting from this system remained unclear. We aimed to identify a subset of trauma patients likely to receive the greatest benefits from the hybrid ER.
This retrospective cohort study was conducted in a tertiary hospital in Japan from August 2007 to January 2020. We consecutively included severe adult blunt trauma patients (Injury Severity Score [ISS], ≥16) and divided them into two groups: conventional group (August 2007 to July 2011) and hybrid ER (August 2011 to January 2020) group. We evaluated the association between the hybrid ER group and 28-day mortality using multivariable logistic regression analysis. The 28-day mortality trend during the study period was evaluated with restricted cubic spline analysis. To evaluate heterogeneity of effects within various patient severities, we evaluated whether the patients' ISS modified the effect of the hybrid ER on survival.
Among 1,050 trauma patients, the conventional group comprised 360 patients and the hybrid ER group comprised 690 patients. Injury Severity Score and probability of survival (Ps) were not significantly different between the groups. Twenty-eight-day mortality was significantly lower in the hybrid ER group (Ps-adjusted odds ratio, 0.48; 95% confidence interval, 0.32-0.71; p < 0.001). Restricted cubic spline analysis revealed that Ps-adjusted 28-day mortality sharply decreased approximately 200 days after installation of the hybrid ER. Increase of survival probabilities according to the increase of ISS was significantly improved in hybrid ER group (p = 0.014). Because ISS increased to >25, survival probabilities in the hybrid ER group were higher compared with those in the conventional group.
The hybrid ER may improve posttraumatic mortality, especially in patients with higher baseline severity.
Therapeutic/care management, level IV.
混合急诊室（ER）系统是一种新型的创伤工作流程，它在创伤复苏室中使用血管造影计算机断层扫描设备。虽然混合 ER 系统缩短了手术和血管内治疗的开始时间，并提高了死亡率，但受益于该系统的最佳目标仍不清楚。我们旨在确定一组可能从混合 ER 中获得最大收益的创伤患者。
这是一项在日本一家三级医院进行的回顾性队列研究，时间为 2007 年 8 月至 2020 年 1 月。我们连续纳入严重成人钝器创伤患者（损伤严重程度评分[ISS]≥16），并将其分为两组：常规组（2007 年 8 月至 2011 年 7 月）和混合 ER 组（2011 年 8 月至 2020 年 1 月）。我们使用多变量逻辑回归分析评估混合 ER 组与 28 天死亡率之间的关系。使用限制性三次样条分析评估研究期间 28 天死亡率的趋势。为了评估不同患者严重程度内效应的异质性，我们评估了患者的 ISS 是否改变了混合 ER 对生存的影响。
在 1050 名创伤患者中，常规组 360 例，混合 ER 组 690 例。两组的损伤严重程度评分和生存概率（Ps）无显著差异。混合 ER 组 28 天死亡率显著降低（调整后的优势比，0.48；95%置信区间，0.32-0.71；p<0.001）。限制性三次样条分析显示，混合 ER 安装后约 200 天，调整后的 Ps 28 天死亡率急剧下降。混合 ER 组的生存概率随 ISS 的增加而显著提高（p=0.014）。由于 ISS 增加到>25，混合 ER 组的生存概率高于常规组。
混合 ER 可能改善创伤后死亡率，特别是在基线严重程度较高的患者中。
治疗/护理管理，IV 级。
