Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, University of South Florida, Tampa, FL, USA.
Am Surg. 2022 Sep;88(9):2374-2379. doi: 10.1177/00031348211011099. Epub 2021 Apr 20.
Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population.
A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation.
Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years.
DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.
创伤患者的救治始于现场，现场分诊和转运方式是影响患者预后的决定因素。本研究评估了美国创伤人群中死亡于现场（DOA）的全国模式。
对美国外科医师学院（ACS）创伤质量计划参与者使用文件（TQP-PUF）数据集（2013-2017 年）进行了横断面回顾。将报告为 DOA 的创伤患者按 ISS 分为低（<15）、中（15-24）或高（≥25）严重程度。然后，根据患者人口统计学、机制、损伤类型和转运方式将每个组进一步细分。
在 TQP-PUF 数据集的 4336816 例损伤病例中，33199 例为 DOA（0.77%）。77.1%（25604/33199）的 DOA 为男性。在低 ISS 组中，0.36%（13272/3639811）为 DOA；在中 ISS 组中，1.2%（4868/421994）为 DOA；在高 ISS 组中，5.5%（15059/275011）为 DOA。机动车碰撞（MVC）（11262 例）和枪支（8894 例）是最常见的损伤类型，占 DOA 的 60.7%。跌倒占所有 DOA 的 9.1%。最常见的 DOA 年龄组为 18-64 岁，其次为≥65 岁。
DOA 创伤患者主要为成年男性，最常因致命钝性外伤而死亡，最常见的原因是 MVC。DOA 由各种严重程度的损伤引起。我们建议进一步制定预防计划，从而减少常见创伤性损伤（尤其是 MVC、跌倒和枪支）的发生率，以提高生存率。未来的研究还应调查创伤中心的获取和分布情况，以及直升机、地面和警察转运方式以及转运时间对减少 DOA 和改善创伤患者预后的作用。
