Premji Elishah N, Kilindimo Said S, Sawe Hendry R, Yussuf Amne O, Simbila Alphonce N, Manji Hussein K, Mfinanga Juma A, Weber Ellen J
Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Emerg Med Int. 2022 Nov 4;2022:9611602. doi: 10.1155/2022/9611602. eCollection 2022.
Polytrauma patients require special facilities to care for their injuries. In HICs, these patients are rapidly transferred from the scene or the first-health facility directly to a trauma center. However, in many LMICs, prehospital systems do not exist and there are long delays between arrivals at the first-health facility and the trauma center. We aimed to quantify the delay and determine the predictors of mortality among polytrauma patients. . We consecutively enrolled adult polytrauma patients (≥18 years) with ISS >15 referred to the Emergency Medicine Department of Muhimbili National Hospital, a major trauma center in Tanzania between August 2019 and January 2020. Based on a pilot study, the arrival of >6 hours after injury was considered a delay. The outcome of interest was factors associated with delayed presentation and the association of timeliness with 7-day mortality.
We enrolled 120 (4.5%) referred polytrauma adult patients. The median age was 30 years (IQR 25-39) and the ISS was 29 (IQR 24-34). The majority (85%) were males. While the median time from injury to first-health facility was 40 minutes (IQR 33-50), the median time from injury to arrival at EMD-MNH, was 377 minutes (IQR 314-469). Delayed presentation was noted in more than half (54.2%) of participants, with the odds of dying being 1.4 times higher in the delayed group (95% CI 0.3-5.6). Having a GCS <8 (AOR 16.3 (95% CI 3.1-86.3), hypoxia <92% (AOR 8.3 (95% CI 1.4-50.9), and hypotension <90 mmHg (R 7.3 (95% CI 1.6-33.6) were all independent predictors of mortality.
The majority of polytrauma patients arrive at the tertiary facilities delayed for more than 6 hours and a distance of more than 8 km between facilities is associated with delay. Hypotension, hypoxia, and GCS of less than 8 are independent predictors of poor outcome. In the interim, there is a need to expedite the transfer of polytrauma patients to trauma care capable centers.
多发伤患者需要特殊的设施来护理其损伤。在高收入国家（HICs），这些患者会迅速从现场或一级医疗机构直接转运至创伤中心。然而，在许多低收入和中等收入国家（LMICs），院前系统并不存在，且从到达一级医疗机构到创伤中心之间存在长时间延误。我们旨在量化这种延误，并确定多发伤患者的死亡预测因素。我们连续纳入了2019年8月至2020年1月期间转诊至坦桑尼亚主要创伤中心穆希姆比利国家医院急诊科的成年多发伤患者（≥18岁），损伤严重度评分（ISS）>15。基于一项试点研究，受伤后超过6小时到达被视为延误。感兴趣的结果是与延迟就诊相关的因素以及及时性与7天死亡率的关联。
我们纳入了120名（4.5%）转诊的成年多发伤患者。中位年龄为30岁（四分位间距25 - 39岁），ISS为29（四分位间距24 - 34）。大多数（85%）为男性。虽然从受伤到一级医疗机构的中位时间为40分钟（四分位间距33 - 50分钟），但从受伤到到达穆希姆比利国家医院急诊科的中位时间为377分钟（四分位间距314 - 469分钟）。超过一半（54.2%）的参与者存在延迟就诊情况，延迟组的死亡几率高出1.4倍（95%置信区间0.3 - 5.6）。格拉斯哥昏迷量表（GCS）<8（调整后比值比[AOR] 16.3（95%置信区间3.1 - 86.3）、血氧饱和度<92%（AOR 8.3（95%置信区间1.4 - 50.9）以及收缩压<90 mmHg（AOR 7.3（95%置信区间1.6 - 33.6）均为死亡的独立预测因素。
大多数多发伤患者到达三级医疗机构时延迟超过6小时，且机构间距离超过8公里与延迟相关。低血压、低氧血症以及GCS小于8是不良结局的独立预测因素。在此期间，有必要加快将多发伤患者转运至具备创伤护理能力的中心。
