紧急剖宫产术后的旅行时间和围产儿死亡率：塞拉利昂对 2 小时临近指标的评估。
Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone.
机构信息
Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
出版信息
BMJ Glob Health. 2020 Dec;5(12). doi: 10.1136/bmjgh-2020-003943.
INTRODUCTION
Longer travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance.
METHODS
Women who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma ; model II Munoz ). Patient-reported and modelled travel times were compared applying a univariable linear regression analysis, and the relation between travel time and perinatal mortality was assessed.
RESULTS
The median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001).
CONCLUSION
The standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off.
简介
较长的旅行时间与产妇和围产儿不良结局的增加有关。地理空间建模已越来越多地用于估计紧急产科护理中的地理接近度。在这项研究中，我们旨在评估模型和患者报告的旅行时间之间的相关性，并评估其临床相关性。
方法
在 9 家医院行剖宫产分娩的妇女在 1 个月和 1 年内进行家庭随访。根据两种模型（模型 I Ouma ；模型 II Munoz ），估计分娩前位置与行剖宫产的医疗机构之间的旅行时间。应用单变量线性回归分析比较患者报告的和模型估计的旅行时间，并评估旅行时间与围产儿死亡率的关系。
结果
报告的中位数旅行时间为 60 分钟，而两种模型分别估计为 13 分钟和 34 分钟。2 小时的可达性阈值与模型 I 的患者报告旅行时间 5.7 小时和模型 II 的 1.8 小时相关。较长的旅行时间与乘船和救护车运输、在到达最终医疗机构之前访问一个或两个医疗机构、较低的教育水平和贫困有关。在报告的旅行时间为 2 小时或更短的组（每 1000 例活产 193 例与 308 例，p<0.001）和模型估计的旅行时间为 2 小时或更短的组（模型 I：每 1000 例活产 209 例与 344 例，p=0.003；模型 II：每 1000 例活产 181 例与 319 例，p<0.001）中，围产儿死亡率较低。
结论
用于估计地理接近度的标准模型始终低估了旅行时间。然而，保守的旅行时间模型更符合患者报告的旅行时间。《柳叶刀全球手术委员会》确定的 2 小时阈值与降低围产儿死亡相关，具有临床意义，但并非明确的截止值。
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