Hibberd Owen, Price James, Laurent Amy, Agrawal Shruti, Barnard Ed
Department of Emergency Medicine, Blizard Institute, Queen Mary University of London, London, GBR.
Department of Emergency, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.
Cureus. 2023 Mar 28;15(3):e36808. doi: 10.7759/cureus.36808. eCollection 2023 Mar.
Background More than half of seriously injured children are not initially treated at a major trauma centre (MTC). Children may be transported by private vehicle to a trauma unit (TU). Children may also be transported by emergency medical services (EMS) to the nearest TU with approximately one in five of these undergoing secondary transfer to an MTC. Most trauma networks permit TU bypass to an MTC. However, the evidence on outcomes between transfer and bypass is limited. This study aimed to evaluate the use of the trauma network by comparing outcomes between paediatric major trauma patients by the method of presentation. Methods In this retrospective observational study, a consecutive sample of paediatric (<16 years old) major trauma patients transported to the regional MTC (Cambridge University Hospitals NHS Foundation Trust (CUH)) between 1st January 2015 and 31st December 2020 was included. Patients were excluded if they arrived at the MTC >24 hours post-injury or were transported to the MTC as the nearest hospital. Patients were divided into four groups: self-presented to MTC, MTC as nearest hospital, bypass and secondary transfer. Results A total of 315 patients (28 'self-presented', 55 'nearest', 58 'bypass' and 174 'secondary transfers') were included. The median age was 9.4 [3.7-13.6] years, and =209 (66.3%) were male. The median Injury Severity Score (ISS) was 16.0 [9.0-25.0] and =190 (60.3%) had an ISS >15. There was no difference in 30-day mortality between the 'bypass' and 'secondary transfer' groups. There was a significantly longer hospital and intensive care unit length of stay (LOS) in the bypass group compared to other groups, both <0.001. The median time to definitive care was five hours greater in the secondary transfer group compared to 'bypass' (bypass 117.6 minutes [100.8-136.6], secondary transfer 418.8 minutes [315.6-529.8]). Conclusion There was no significant difference in 30-day mortality of paediatric major trauma patients who underwent secondary transfer compared to those transported directly from the scene to the MTC, despite significant time delays in reaching definitive care.
超过半数的重伤儿童最初并非在大型创伤中心（MTC）接受治疗。儿童可能由私家车转运至创伤单元（TU）。儿童也可能由紧急医疗服务（EMS）转运至最近的TU，其中约五分之一的儿童会被二次转运至MTC。大多数创伤网络允许绕过TU直接转运至MTC。然而，关于转运和直接绕过的结局的证据有限。本研究旨在通过比较儿科严重创伤患者不同就诊方式的结局，评估创伤网络的使用情况。方法：在这项回顾性观察研究中，纳入了2015年1月1日至2020年12月31日期间被转运至地区MTC（剑桥大学医院国民保健服务基金会信托基金（CUH））的儿科（<16岁）严重创伤患者的连续样本。如果患者在受伤后>24小时到达MTC或被转运至MTC作为最近的医院，则被排除。患者被分为四组：自行前往MTC、MTC为最近的医院、直接绕过和二次转运。结果：共纳入315例患者（28例“自行前往”、55例“最近的医院”、58例“直接绕过”和174例“二次转运”）。中位年龄为9.4[3.7 - 13.6]岁，209例（66.3%）为男性。中位损伤严重度评分（ISS）为16.0[9.0 - 25.0]，190例（60.3%）的ISS>15。“直接绕过”组和“二次转运”组的30天死亡率无差异。与其他组相比，直接绕过组的住院时间和重症监护病房住院时间（LOS）显著更长，均<0.001。二次转运组至确定性治疗的中位时间比“直接绕过”组多5小时（直接绕过117.6分钟[100.8 - 136.6]，二次转运418.8分钟[315.6 - 529.8]）。结论：与直接从现场转运至MTC的儿科严重创伤患者相比，二次转运患者的30天死亡率无显著差异，尽管在获得确定性治疗方面存在明显的时间延迟。
