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创伤团队对高级别肝损伤治疗的影响:台湾一项长达二十年的倾向评分匹配研究。

Impact of trauma teams on high grade liver injury care: a two-decade propensity score approach study in Taiwan.

机构信息

Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.

Division of General Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.

出版信息

Sci Rep. 2023 Apr 3;13(1):5429. doi: 10.1038/s41598-023-32760-9.

Abstract

High-grade liver laceration is a common injury with bleeding as the main cause of death. Timely resuscitation and hemostasis are keys to the successful management. The impact of in-hospital trauma system on the quality of resuscitation and management in patients with traumatic high-grade liver laceration, however, was rarely reported. We retrospectively reviewed the impact of team-based approach on the quality and outcomes of high-grade traumatic liver laceration in our hospital. Patients with traumatic liver laceration between 2002 and 2020 were enrolled in this retrospective study. Inverse probability of treatment weighting (IPTW)-adjusted analysis using the propensity score were performed. Outcomes before the trauma team establishment (PTTE) and after the trauma team establishment (TTE) were compared. A total of 270 patients with liver trauma were included. After IPTW adjustment, interval between emergency department arrival and managements was shortened in the TTE group with a median of 11 min (p < 0.001) and 28 min (p < 0.001) in blood test reports and duration to CT scan, respectively. Duration to hemostatic treatments in the TTE group was also shorter by a median of 94 min in patients receiving embolization (p = 0.012) and 50 min in those undergoing surgery (p = 0.021). The TTE group had longer ICU-free days to day 28 (0.0 vs. 19.0 days, p = 0.010). In our study, trauma team approach had a survival benefit for traumatic high-grade liver injury patients with 65% reduction of risk of death within 72 h (Odds ratio (OR) = 0.35, 95% CI = 0.14-0.86) and 55% reduction of risk of in-hospital mortality (OR = 0.45, 95% CI = 0.23-0.87). A team-based approach might contribute to the survival benefit in patients with traumatic high-grade liver laceration by facilitating patient transfer from outside the hospital, through the diagnostic examination, and to the definitive hemostatic procedures.

摘要

高等级肝损伤是一种常见的损伤,出血是导致死亡的主要原因。及时复苏和止血是成功治疗的关键。然而,关于院内创伤系统对创伤性高等级肝损伤患者复苏和管理质量的影响,鲜有报道。我们回顾性分析了基于团队的方法对我院高等级创伤性肝损伤患者质量和结局的影响。本回顾性研究纳入了 2002 年至 2020 年间肝损伤患者。采用倾向评分逆概率治疗加权(IPTW)校正分析。比较创伤团队成立前(PTTE)和创伤团队成立后(TTE)的结局。共纳入 270 例肝外伤患者。经 IPTW 校正后,TTE 组患者从急诊科到达至开始处理的时间中位数分别缩短了 11 分钟(p<0.001)和 28 分钟(p<0.001),血检报告和 CT 扫描时间也分别缩短了 11 分钟(p<0.001)和 28 分钟(p<0.001)。栓塞治疗患者的止血治疗中位时间也缩短了 94 分钟(p=0.012),手术治疗患者的止血治疗中位时间缩短了 50 分钟(p=0.021)。TTE 组患者 ICU 无住院天数到第 28 天的时间中位数延长了 0.0 天(0.0 天对 19.0 天,p=0.010)。在本研究中,创伤团队方法为创伤性高等级肝损伤患者带来了生存获益,72 小时内死亡风险降低了 65%(优势比(OR)=0.35,95%CI=0.14-0.86),院内死亡率降低了 55%(OR=0.45,95%CI=0.23-0.87)。基于团队的方法可能通过促进患者从院外转移、通过诊断检查和进行确定性止血治疗,有助于为创伤性高等级肝损伤患者带来生存获益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2da4/10070483/f36a3e13d8a2/41598_2023_32760_Fig1_HTML.jpg

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