院内死亡率与创伤团队启动的关联:一项为期10年的研究。

Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study.

作者信息

Chien Da-Sen, Yiang Giou-Teng, Liu Chi-Yuan, Tzeng I-Shiang, Chang Chun-Yu, Hou Yueh-Tseng, Chen Yu-Long, Lin Po-Chen, Wu Meng-Yu

机构信息

Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan.

Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.

出版信息

Diagnostics (Basel). 2022 Sep 27;12(10):2334. doi: 10.3390/diagnostics12102334.

Abstract

Background: Early trauma team activation (TTA) may improve clinical outcomes through early diagnosis and timely intervention by a dedicated multidisciplinary team. Controversy seems to exist about the effect of establishing trauma team systems in traumatic injury populations. Our aim was to identify factors that may be associated with clinical outcomes in trauma injury and to investigate the effect of trauma team activation. Method: This retrospective descriptive study included all traumatic patients from the Taipei Tzu Chi Hospital Trauma Database. All prehospital vital signs, management, injury type, injury mechanisms, hospitalization history, and clinical outcomes were analyzed, and multivariable logistic regression was used to investigate the association between trauma team activation and clinical outcomes. Subgroups of TTA in minor injury and non-TTA in major injury were also analyzed. Result: In this study, a total of 11,946 patients were included, of which 10,831 (90.7%) patients were minor injury (ISS < 16), and 1115 (9.3%) patients were major injury (ISS ≥ 16). In the minor injury population, TTA had a higher intensive care unit (ICU) admission rate, operation rate, re-operation rate, and prolonged total length of stay (LOS). In the major injury population, TTA had a higher mortality rate, prolonged total LOS, and prolonged ICU LOS. After adjusting for mechanism of injury and injury severity, there was no association between in-hospital mortality and TTA, compared with the non-TTA group. However, the TTA group had a higher risk of ICU admission, prolonged ICU LOS, and prolonged total LOS. The subgroup analysis showed trauma team activation had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Conclusions: We found there was no significant association between in-hospital mortality and TTA. However, in the TTA group, there was a higher risk of ICU admission, prolonged total, LOS, and prolonged ICU LOS. In the subgroup analysis, TTA had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Our results reflect TTA-criteria-selected patients with greater ISS and a high risk of mortality.

摘要

背景

早期创伤团队启动(TTA)可能通过专门的多学科团队进行早期诊断和及时干预来改善临床结局。关于在创伤性损伤人群中建立创伤团队系统的效果似乎存在争议。我们的目的是确定可能与创伤性损伤临床结局相关的因素,并研究创伤团队启动的效果。方法:这项回顾性描述性研究纳入了台北慈济医院创伤数据库中的所有创伤患者。分析了所有院前生命体征、治疗、损伤类型、损伤机制、住院史和临床结局,并使用多变量逻辑回归研究创伤团队启动与临床结局之间的关联。还分析了轻伤中的TTA亚组和重伤中的非TTA亚组。结果:本研究共纳入11946例患者,其中10831例(90.7%)为轻伤(损伤严重程度评分[ISS]<16),1115例(9.3%)为重伤(ISS≥16)。在轻伤人群中,TTA组的重症监护病房(ICU)入住率、手术率、再次手术率和总住院时间(LOS)延长率更高。在重伤人群中,TTA组的死亡率更高、总LOS延长和ICU LOS延长。在调整损伤机制和损伤严重程度后,与非TTA组相比,住院死亡率与TTA之间无关联。然而,TTA组的ICU入住风险更高、ICU LOS延长和总LOS延长。亚组分析显示,创伤团队启动在60至80岁人群、重伤(ISS≥16)、意识清醒人群和非头部损伤组中死亡率风险更高。结论:我们发现住院死亡率与TTA之间无显著关联。然而,在TTA组中,ICU入住风险更高、总LOS延长和ICU LOS延长。在亚组分析中,TTA在60至80岁人群、重伤(ISS≥16)、意识清醒人群和非头部损伤组中死亡率风险更高。我们的结果反映了根据TTA标准选择的患者ISS更高且死亡率风险高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfa9/9600103/bfeceaacdbc4/diagnostics-12-02334-g001.jpg

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