儿科创伤患者向更高层级医疗机构的院际转运：转运时间和接收创伤中心层级的影响。
Interfacility transfer of pediatric trauma patients to higher levels of care: The effect of transfer time and level of receiving trauma center.
机构信息
From the Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
出版信息
J Trauma Acute Care Surg. 2023 Sep 1;95(3):383-390. doi: 10.1097/TA.0000000000003915. Epub 2023 Feb 2.
BACKGROUND
Interfacility transfer of pediatric trauma patients to pediatric trauma centers (PTCs) after evaluation in nontertiary centers is associated with improved outcomes. We aimed to assess the outcomes of transferred pediatric patients based on their severity of the injury, transfer time, and level of receiving PTCs.
METHODS
This is a 3-year (2017-2019) analysis of the American College of Surgeons Trauma Quality Improvement Program database. All children (younger than 15 years) who were transferred from other facilities to Level I or II PTC were included and stratified by level of receiving PTCs and injury severity. Outcome measures were in-hospital mortality and major complications.
RESULTS
A total of 67,726 transferred pediatric trauma patients were identified, of which 52,755 were transferred to Level I and 14,971 to Level II. The mean ± SD age and median Injury Severity Score were 7 ± 4 years and 4 (1-6), respectively. Eighty-five percent were transported by ground ambulance. The median transfer time for Levels I and II was 93 (70-129) and 90 (66-128) minutes, respectively ( p < 0.001). On multivariable regression, interfacility transfers to Level I PTCs were associated with decreased risk-adjusted odds of in-hospital mortality among the mildly to moderately injured group (adjusted odds ratio, 0.59; p = 0.037) and severely injured group with a transfer time of less than 60 minutes (adjusted odds ratio, 0.27; p = 0.002).
CONCLUSION
Every minute increase in the interfacility transfer time is associated with a 2% increase in risk-adjusted odds of mortality among severely injured pediatric trauma patients. Factors other than the level of receiving PTCs, such as estimated transfer time and severity of injury, should be considered while deciding about transferring pediatric trauma patients to higher levels of care.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
背景
在非三级中心评估后，将儿科创伤患者转至儿科创伤中心（PTC）与改善结局相关。我们旨在根据受伤严重程度、转院时间和接收 PTC 级别评估转院儿科患者的结局。
方法
这是美国外科医师学会创伤质量改进计划数据库的一项 3 年（2017-2019 年）分析。所有从其他机构转至 I 级或 II 级 PTC 的儿童（年龄小于 15 岁）均纳入研究，并根据接收 PTC 级别和受伤严重程度进行分层。结局指标为院内死亡率和主要并发症。
结果
共确定 67726 例转院儿科创伤患者，其中 52755 例转至 I 级，14971 例转至 II 级。平均（±SD）年龄和中位数损伤严重度评分分别为 7（±4）岁和 4（1-6）分。85%由地面救护车转运。I 级和 II 级的中位转院时间分别为 93（70-129）和 90（66-128）分钟（p<0.001）。多变量回归分析显示，对于轻度至中度受伤组（调整后比值比，0.59；p=0.037）和 60 分钟内转运的严重受伤组，转至 I 级 PTC 与降低风险调整后院内死亡率的几率相关。
结论
在严重受伤的儿科创伤患者中，每增加 1 分钟的院间转运时间，风险调整后死亡率的几率就会增加 2%。在决定将儿科创伤患者转至更高级别治疗时，应考虑 PTC 接收级别以外的因素，如估计转院时间和受伤严重程度。
证据等级
治疗/护理管理；III 级。
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