Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.
Department of Paediatric Surgery, Skåne University Hospital, Lund, Sweden.
BJS Open. 2021 May 7;5(3). doi: 10.1093/bjsopen/zrab036.
It is unclear how the length of prehospital transport time affects outcome in paediatric trauma. This study evaluated the association of transport time from alarm to arrival at hospital with adverse outcome in paediatric trauma patients in Sweden.
This was a retrospective study based on prospectively collected data from the Swedish trauma registry between 2012 and 2019 of children less than 18 years with major trauma (New Injury Severity Score (NISS) greater than 15). The primary outcome was 30-day mortality, and secondary outcomes were emergency interventions (e.g., chest tube or laparotomy) and low functional outcome (Glasgow Outcome Scale 2-3). Primary exposure was transport time from alarm to arrival at hospital. Co-variables in multivariable regressions were gender, age, ASA score before injury, injury intention, dominant injury type, NISS, Glasgow Coma Scale score, prehospital competence and hospital level.
Among 597 patients, 30-day mortality was 9.8 per cent, emergency interventions were performed in 34.7 per cent and low functional outcome was registered in 15.9 per cent. Median transport time was 51 (i.q.r. 37-68) minutes. After adjustment for patient, injury and hospital characteristics, no association between longer transport time and 30-day mortality, frequency of emergency interventions or lower functional outcome could be found. Treatment at a university hospital was associated with a lower risk for 30-day mortality (odds ratio 0.23 (95 per cent c.i. 0.08 to 0.68), P = 0.008).
Longer transport time after major paediatric trauma was not associated with adverse outcome. Hence, it seems that longer transport distances should not be an obstacle against centralization of paediatric trauma care. Further studies should focus on the role of prehospital competence and other transport-associated parameters and their association with adverse outcome.
目前尚不清楚院前转运时间的长短如何影响儿科创伤患者的结局。本研究评估了瑞典儿科创伤患者从报警到入院的转运时间与不良结局之间的关系。
这是一项基于 2012 年至 2019 年瑞典创伤登记处前瞻性收集数据的回顾性研究，纳入年龄小于 18 岁、创伤严重程度评分（NISS）大于 15 的主要创伤患儿。主要结局为 30 天死亡率，次要结局为急诊干预（如胸腔引流管或剖腹探查）和低功能结局（格拉斯哥结局量表 2-3 分）。主要暴露因素为从报警到入院的转运时间。多变量回归中的协变量包括性别、年龄、受伤前的 ASA 评分、受伤意图、主要损伤类型、NISS、格拉斯哥昏迷评分、院前能力和医院级别。
在 597 例患者中，30 天死亡率为 9.8%，34.7%的患者行急诊干预，15.9%的患者出现低功能结局。转运时间中位数为 51 分钟（IQR 37-68）。在校正了患者、损伤和医院特征后，未发现较长的转运时间与 30 天死亡率、急诊干预的频率或较低的功能结局之间存在关联。在大学医院接受治疗与降低 30 天死亡率的风险相关（比值比 0.23（95%可信区间 0.08 至 0.68），P=0.008）。
儿科严重创伤后较长的转运时间与不良结局无关。因此，较长的转运距离似乎不应成为集中儿科创伤救治的障碍。进一步的研究应集中在院前能力和其他与转运相关的参数及其与不良结局的关系上。
