Emergency Department, University Hospital of Lausanne, Switzerland.
Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
Swiss Med Wkly. 2021 Sep 1;151(35-36). doi: 10.4414/SMW.2021.w30007.
Rapid access to a trauma centre for severely injured road accident victims, conceptualised as the Golden Hour, links access time to definitive treatment within 1 hour of trauma with reduced risks of morbidity and mortality. Access times have not been studied in Switzerland. The aim of this work was to model the transport time by ambulance of seriously injured road traffic accident victims to one of the 12 trauma centres in Switzerland and to investigate whether this time influenced mortality.
Isochronous travel curves in 10-minute increments were modelled around each of the 12 Swiss trauma centres to assess travel times at the Swiss national level, based on the shortest travel time from the location of a serious road accident to the nearest trauma centre. We used the national database of the Federal Roads Office, which provided the geolocation of these accidents occurring between 2011 and 2017. The association between mortality and transport time to the nearest trauma centre was then analysed.
The current distribution of trauma centres allowed access time within the Golden Hour for accidents occurring on the Swiss plateau, but the time was more prolonged in the Alps or the Jura. An association existed between mortality and prehospital transport time from the site of an accident to the nearest trauma centre. For each additional 10-minute isochrone, an average increase of 0.4% in mortality was observed.
This work showed an adequate distribution of trauma centres in Switzerland and suggests a positive relationship between transport time to the nearest trauma centre and mortality. The numerous confounding factors not systematically collected in publicly available databases limit the robustness of our results. This study confirms the importance of having a national trauma registry to allow quality analyses to guide public health decisions.
对于严重创伤事故受害者，快速进入创伤中心，即“黄金时间”的概念，将到达时间与创伤后 1 小时内的确定性治疗联系起来，从而降低发病率和死亡率。瑞士尚未对到达时间进行研究。本研究旨在构建瑞士 12 个创伤中心之一的严重道路交通事故受害者的救护车转运时间，并探讨该时间是否会影响死亡率。
基于从严重道路事故地点到最近创伤中心的最短旅行时间，在瑞士 12 个创伤中心周围的 10 分钟间隔内构建等时旅行曲线，以评估瑞士全国范围内的旅行时间。我们使用联邦公路局的国家数据库，该数据库提供了这些发生在 2011 年至 2017 年之间的事故的地理位置。然后分析死亡率与到最近创伤中心的转运时间之间的关系。
目前的创伤中心分布使瑞士高原地区发生的事故在黄金时间内可以获得治疗，但在阿尔卑斯山或汝拉山地区则需要更长的时间。死亡率与从事故现场到最近创伤中心的院前转运时间之间存在关联。每增加 10 分钟的等时线，死亡率平均增加 0.4%。
本研究表明瑞士的创伤中心分布合理，并提示从事故现场到最近创伤中心的转运时间与死亡率之间存在正相关关系。由于许多混杂因素未在公开数据库中系统收集，限制了我们结果的稳健性。本研究证实了建立国家创伤登记册的重要性，以允许进行质量分析，从而指导公共卫生决策。
