Vestrup J A, Stormorken A, Wood V
Department of Surgery, University of British Columbia, Vancouver, Canada.
Am J Surg. 1988 May;155(5):704-7. doi: 10.1016/s0002-9610(88)80150-8.
To assess the impact of ATLS education on early trauma management, charts of patients with an ISS of 14 or greater were reviewed for a 1 year period before and after ATLS training of emergency room trauma care providers. There were 50 patients in the before ATLS group, with a mean age of 41.6 years and an ISS of 29.8, and 71 patients in the after ATLS group, with a mean age of 40.6 years and an ISS of 30.6. Of those parameters evaluated as measures of early assessment, only rectal examination was found to be performed significantly more frequently after ATLS training. The mortality rates of 26 percent before ATLS and 20 percent after ATLS were not significantly different. In evaluating assessment and management parameters in the patients who died, no airway management errors were found in the after ATLS group; however, there were more missed injuries in this group. We have concluded that ATLS instruction failed to produce a quantifiable improvement in patient assessment or outcome. Further studies directed at assessing the retention rate for ATLS education and determining the impact on clinical performance are needed.
为评估高级创伤生命支持（ATLS）教育对早期创伤管理的影响，我们回顾了急诊室创伤护理人员接受ATLS培训前后1年期间，损伤严重度评分（ISS）为14或更高的患者病历。ATLS培训前组有50例患者，平均年龄41.6岁，ISS为29.8；ATLS培训后组有71例患者，平均年龄40.6岁，ISS为30.6。在作为早期评估指标进行评估的参数中，只有直肠检查在ATLS培训后进行得明显更频繁。ATLS培训前死亡率为26%，培训后为20%，两者无显著差异。在评估死亡患者的评估和管理参数时，ATLS培训后组未发现气道管理错误；然而，该组漏诊损伤更多。我们得出结论，ATLS指导未能在患者评估或结果方面产生可量化的改善。需要进一步开展研究，以评估ATLS教育的保留率并确定其对临床绩效的影响。
