转移状态对中低收入国家创伤结局的影响：系统评价和荟萃分析。
The effect of transfer status on trauma outcomes in low- and middle-income countries: A systematic review and meta-analysis.
机构信息
Department of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, United States.
Department of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, United States; Kamuzu Central Hospital, Lilongwe, Malawi.
出版信息
Injury. 2022 Mar;53(3):885-894. doi: 10.1016/j.injury.2021.10.010. Epub 2021 Oct 13.
INTRODUCTION
Injuries are a leading cause of disability and death worldwide, and low- and middle-income countries (LMICs) are disproportionately burdened by trauma. Prior studies have shown that transfer status (direct transfer from injury scene to a referral hospital versus indirect transfer from another facility to a referral hospital) may affect patient outcomes. The purpose of this study is to evaluate the relationship between transfer status and trauma patient outcomes in LMICs by conducting a systematic review and meta-analysis.
METHODS
We performed a systematic search to identify studies from LMICs that evaluated the relationship between transfer status and trauma patient outcomes. We extracted data on study country, design, patient characteristics, and outcomes. We report results in the form of a narrative summary stratified by type of outcome. We also performed a meta-analysis of studies that reported mortality by transfer status. We calculated a pooled odds ratio of mortality among indirectly transferred (IT) versus directly transferred (DT) patients using random-effects modeling.
RESULTS
We included 17 observational studies from 9 LMICs in this systematic review. Outcomes assessed were time from injury to arrival at a referral hospital, post-trauma functional status, hospital length of stay, and mortality. IT patients took between 0.6 and 37.9 h longer to arrive at referral hospitals than DT patients. Hospital length of stay was up to 6 days longer for IT patients than DT patients. The pooled odds ratio of mortality among IT patients compared to DT patients was 1.55 (95% CI 1.12 - 2.15; p = 0.009).
CONCLUSION
Trauma patients in LMICs who are indirectly transferred to referral hospitals have significantly higher mortality rates than patients who present directly to referral hospitals. These results conflict with findings from HICs and reflect the relative immaturity of trauma systems in LMICs. Strategies to narrow the mortality gap between IT and DT patients include improving prehospital and primary hospital care and developing more efficient transfer protocols.
简介
在全球范围内，伤害是导致残疾和死亡的主要原因，而低收入和中等收入国家（LMICs）则承受着不成比例的创伤负担。先前的研究表明，转运状态（直接从受伤现场转运到转诊医院与从另一家医疗机构间接转运到转诊医院）可能会影响患者的结局。本研究旨在通过系统评价和荟萃分析评估 LMICs 中转运状态与创伤患者结局之间的关系。
方法
我们进行了系统搜索，以确定评估转运状态与创伤患者结局之间关系的来自 LMICs 的研究。我们提取了关于研究国家、设计、患者特征和结局的数据。我们以按结局类型分层的叙述性摘要形式报告结果。我们还对报告按转运状态分类的死亡率的研究进行了荟萃分析。我们使用随机效应模型计算间接转运（IT）与直接转运（DT）患者之间死亡率的合并比值比。
结果
我们在这项系统评价中纳入了来自 9 个 LMICs 的 17 项观察性研究。评估的结局包括从受伤到到达转诊医院的时间、创伤后功能状态、住院时间和死亡率。与 DT 患者相比，IT 患者到达转诊医院的时间长 0.6 至 37.9 小时。IT 患者的住院时间比 DT 患者长 6 天。与 DT 患者相比，IT 患者的死亡率合并比值比为 1.55（95%CI 1.12-2.15；p=0.009）。
结论
与直接转至转诊医院的患者相比，LMICs 中转运至转诊医院的创伤患者的死亡率显著更高。这些结果与高收入国家的发现相矛盾，反映了 LMICs 中创伤系统的相对不成熟。缩小 IT 与 DT 患者之间死亡率差距的策略包括改善院前和初级医院护理以及制定更有效的转运方案。
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