伤员长时间救治：将平民数据外推至军事环境。
Prolonged casualty care: Extrapolating civilian data to the military context.
机构信息
From the Department of Emergency Medicine (N.-.K.M.-.M., N.K.B., J.M.D., C.P., S.K., A.A.G., V.S.B.), School of Medicine, University of Colorado Denver; Adult and Child Consortium for Health Outcomes Research and Delivery Science (B.B.), University of Colorado Anschutz Medical Campus; Department of Biostatistics and Informatics (K.S.), Colorado School of Public Health, University of Colorado, Aurora, Colorado; Emergency Medical Services, Department of Health (S.d.V.), Western Cape Government; Department of Surgery (H.J.L., E.S.) and Division of Forensic Medicine, Department of Pathology (J.V.), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; US Army Institute of Surgical Research (S.G.S.), Joint Base San Antonio, Fort Sam Houston, Texas; Brooke Army Medical Center (T.E.B.), Fort Sam Houston, Texas; Joint Trauma System (C.C., S.K.), Defense Health Agency, Fort Sam Houston, Texas; The Center for COMBAT Research, Department of Emergency Medicine (S.K.), School of Medicine, University of Colorado, Aurora; Ernest E Moore Shock Trauma Center at Denver Health (E.E.M.), University of Colorado Denver; and Division of Emergency Medicine (L.A.W.), University of Cape Town, Cape Town, South Africa.
出版信息
J Trauma Acute Care Surg. 2022 Aug 1;93(2S Suppl 1):S78-S85. doi: 10.1097/TA.0000000000003675. Epub 2022 May 21.
BACKGROUND
Civilian and military populations alike are increasingly faced with undesirable situations in which prehospital and definitive care times will be delayed. The Western Cape of South Africa has some similarities in capabilities, injury profiles, resource limitations, and system configuration to US military prolonged casualty care (PCC) settings. This study provides an initial description of civilians in the Western Cape who experience PCC and compares the PCC and non-PCC populations.
METHODS
We conducted a 6-month analysis of an ongoing, prospective, large-scale epidemiologic study of prolonged trauma care in the Western Cape (Epidemiology and Outcomes of Prolonged Trauma Care [EpiC]). We define PCC as ≥10 hours from injury to arrival at definitive care. We describe patient characteristics, critical interventions, key times, and outcomes as they may relate to military PCC and compare these using χ 2 and Wilcoxon tests. We estimated the associations between PCC status and the primary and secondary outcomes using logistic regression models.
RESULTS
Of 995 patients, 146 experienced PCC. The PCC group, compared with non-PCC, were more critically injured (66% vs. 51%), received more critical interventions (36% vs. 29%), and had a greater proportionate mortality (5% vs. 3%), longer hospital stays (3 vs. 1 day), and higher Sequential Organ Failure Assessment scores (5 vs. 3). The odds of 7-day mortality and a Sequential Organ Failure Assessment score of ≥5 were 1.6 (odds ratio, 1.59; 95% confidence interval, 0.68-3.74) and 3.6 (odds ratio, 3.69; 95% confidence interval, 2.11-6.42) times higher, respectively, in PCC versus non-PCC patients.
CONCLUSION
The EpiC study enrolled critically injured patients with PCC who received resuscitative interventions. Prolonged casualty care patients had worse outcomes than non-PCC. The EpiC study will be a useful platform to provide ongoing data for PCC relevant analyses, for future PCC-focused interventional studies, and to develop PCC protocols and algorithms. Findings will be relevant to the Western Cape, South Africa, other LMICs, and military populations experiencing prolonged care.
LEVEL OF EVIDENCE
Therapeutic/care management; Level IV.
背景
平民和军人都越来越多地面临着院前和确定性治疗时间将延迟的不理想情况。南非西开普省在能力、损伤谱、资源限制和系统配置方面与美国军事延长伤员救治（PCC）环境有一些相似之处。本研究初步描述了在西开普省经历 PCC 的平民，并比较了 PCC 和非 PCC 人群。
方法
我们对西开普省正在进行的、前瞻性的、大规模的延长创伤救治的流行病学研究（Epidemiology and Outcomes of Prolonged Trauma Care [EpiC]）进行了 6 个月的分析。我们将 PCC 定义为从受伤到到达确定性治疗的时间≥10 小时。我们描述了患者特征、关键干预措施、关键时间和结果，因为它们可能与军事 PCC 有关，并使用 χ 2 和 Wilcoxon 检验进行比较。我们使用逻辑回归模型估计 PCC 状态与主要和次要结局之间的关联。
结果
在 995 名患者中，有 146 名患者经历了 PCC。与非 PCC 相比，PCC 组患者的伤势更严重（66%比 51%），接受的关键干预措施更多（36%比 29%），死亡率更高（5%比 3%），住院时间更长（3 天比 1 天），序贯器官衰竭评估评分更高（5 比 3）。与非 PCC 患者相比，PCC 患者 7 天死亡率和序贯器官衰竭评估评分≥5 的几率分别高 1.6 倍（比值比，1.59；95%置信区间，0.68-3.74）和 3.6 倍（比值比，3.69；95%置信区间，2.11-6.42）。
结论
EpiC 研究纳入了接受复苏干预的严重受伤的 PCC 患者。与非 PCC 患者相比，接受延长伤员救治的患者预后更差。EpiC 研究将是一个有用的平台，可提供与 PCC 相关分析的持续数据、未来的 PCC 重点干预研究，并制定 PCC 协议和算法。研究结果将与南非西开普省、其他 LMIC 地区和经历延长救治的军事人群相关。
证据水平
治疗/护理管理；四级。
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