Murao Shuhei, Yamakawa Kazuma, Kabata Daijiro, Kinoshita Takahiro, Umemura Yutaka, Shintani Ayumi, Fujimi Satoshi
Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka 558-8558, Japan.
Department of Emergency Medicine, Osaka Medical College, Takatsuki 569-8686, Japan.
J Clin Med. 2021 Apr 6;10(7):1522. doi: 10.3390/jcm10071522.
Blunt trauma is a potentially life-threatening injury that requires prompt diagnostic examination and therapeutic intervention. Nevertheless, how impactful a rapid response time is on mortality or functional outcomes has not been well-investigated. This study aimed to evaluate effects of earlier door-to-computed tomography time (D2CT) and door-to-bleeding control time (D2BC) on clinical outcomes in severe blunt trauma. This was a single-center, retrospective cohort study of patients with severe blunt trauma (Injury Severity Score > 16). To assess the effect of earlier D2CT and D2BC on clinical outcomes, we conducted multivariable regression analyses with a consideration for nonlinear associations. Among 671 patients with severe blunt trauma who underwent CT scanning, 163 patients received an emergency bleeding control procedure. The median D2CT and D2BC were 19 min and 57 min, respectively. In a Cox proportional hazard regression model, earlier D2CT was not associated with improved 28-day mortality ( = 0.30), but it was significantly associated with decreased mortality from exsanguination ( = 0.003). Earlier D2BC was significantly associated with improved 28-day mortality ( = 0.026). In conclusion, earlier time to a hemostatic procedure was independently associated with decreased mortality. Meanwhile, time benefits of earlier CT examination were not observed for overall survival but were observed for decreased mortality from exsanguination.
钝性创伤是一种潜在的危及生命的损伤，需要及时进行诊断检查和治疗干预。然而，快速反应时间对死亡率或功能结局的影响尚未得到充分研究。本研究旨在评估更早的门到计算机断层扫描时间（D2CT）和门到出血控制时间（D2BC）对严重钝性创伤临床结局的影响。这是一项针对严重钝性创伤患者（损伤严重度评分>16）的单中心回顾性队列研究。为了评估更早的D2CT和D2BC对临床结局的影响，我们进行了多变量回归分析，并考虑了非线性关联。在671例接受CT扫描的严重钝性创伤患者中，163例接受了紧急出血控制手术。D2CT和D2BC的中位数分别为19分钟和57分钟。在Cox比例风险回归模型中，更早的D2CT与28天死亡率的改善无关（ = 0.30），但与失血性死亡率的降低显著相关（ = 0.003）。更早的D2BC与28天死亡率的改善显著相关（ = 0.026）。总之，更早进行止血手术的时间与死亡率降低独立相关。同时，未观察到更早进行CT检查对总体生存的时间益处，但观察到其对降低失血性死亡率有益。
