Centre for Urgent and Emergency Care Research, University of Sheffield School of Health and Related Research, Sheffield, UK.
Trauma Audit and Research Network, Clinical Science Building, Salford Royal Hospital, Salford, UK.
Br J Neurosurg. 2022 Feb;36(1):31-37. doi: 10.1080/02688697.2020.1858026. Epub 2020 Dec 16.
Major trauma triage within regional trauma networks (RTN) select patients with suspected TBI for bypass to specialist neuroscience centres (SNC), expediting neurosurgical care but may delay resuscitation. This comparative effectiveness study assessed the impact of this strategy on the risk adjusted hospital survival rates of patients confirmed to have intracranial injury on brain computed tomography (CT) scan.
A retrospective cohort study was conducted using Trauma Audit and Research Network trauma registry data. Adult patients with a TBI on CT scan were included if they presented between June 2015 to February 2016 to SNCs or non-specialist acute hospitals (NSAH) in the North of England (South Cumbria, Lancashire and the North East Region). Patients were identified as having bypassed a nearer NSAH emergency department (ED) to a SNC using google maps. Their standardised excess survival rate was compared to TBI patients who received primary treatment at a NSAH. A multivariate logistic regression model predicting 30-day survival after TBI (Ps14) was used to adjust for variation in casemix between cohorts.
355 patients met the study inclusion criteria, with 89/355 (25%) of TBI patients bypassing a nearer NSAH to a SNC, and 266/355 (75%) receiving primary treatment at an NSAH. The median severity of intracranial injury was equivalent (median Head Abbreviated Injury Scale 4 (IQR 4-5) in each group. There was no statistically significant difference in the standardised excess survival rate between the two cohorts; +6.15% for bypass (95% CI -1.24% to +13.55%) versus -1.12% for non-bypass (95% CI -4.51% to +2.25%).
No statistically significant survival benefit was identified for TBI patients who bypassed the nearest ED to attend a SNC compared to those receiving treatment at the nearest NSAH, however a clinically significant 7% excess survival rate merits a larger study.
区域创伤网络（RTN）中的重大创伤分诊选择疑似创伤性脑损伤（TBI）的患者进行直通专科神经科学中心（SNC），以加快神经外科护理，但可能会延迟复苏。这项比较有效性研究评估了这种策略对在颅脑计算机断层扫描（CT）上确认颅内损伤的患者的风险调整后医院生存率的影响。
使用创伤审核和研究网络创伤登记数据进行回顾性队列研究。如果患者在 2015 年 6 月至 2016 年 2 月期间在英格兰北部的 SNC 或非专科急症医院（NSAH）就诊，且 CT 扫描显示有 TBI，则纳入本研究。通过谷歌地图确定患者从较近的 NSAH 急诊室转诊到 SNC。使用多变量逻辑回归模型预测 TBI 后 30 天的生存情况（Ps14），以调整队列间病例组合的差异。
共有 355 名患者符合研究纳入标准，其中 89/355（25%）名 TBI 患者从较近的 NSAH 转诊到 SNC，266/355（75%）名患者在 NSAH 接受了初级治疗。两组患者颅内损伤的严重程度中位数相当（每组的头部损伤严重程度量表 4 分的中位数[四分位距 4-5]）。两组间的标准化超额生存率无统计学差异；转诊组为+6.15%（95%CI -1.24%至+13.55%），而非转诊组为-1.12%（95%CI -4.51%至+2.25%）。
与在最近的 NSAH 接受治疗的患者相比，直通最近的 ED 接受 SNC 治疗的 TBI 患者的生存获益无统计学意义，但 7%的临床显著超额生存率需要更大的研究。
