创伤接收的最初一小时对患有严重胸部创伤的患者至关重要：来自创伤登记处 DGU 的回顾性分析。
The first hour of trauma reception is critical for patients with major thoracic trauma: A retrospective analysis from the TraumaRegister DGU.
机构信息
From the Department of Anaesthesiology & Emergency Medicine, AZ Groeninge Hospital (DH, CM), Department of Cardiovascular Sciences, KU Leuven University campus Kulak, Kortrijk, Belgium Kortrijk Campus, Kortrijk, Belgium (DH, CM), National Trauma Research Institute, Alfred Health & Monash University (DH, MCF), Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia (MCF), Institute for Research in Operative Medicine (IFOM), Universität Witten/Herdecke, Cologne, Germany (RL), Department of Emergency Medicine, UZ Leuven Hospital, (SV), Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium (SV), Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU).
出版信息
Eur J Anaesthesiol. 2023 Nov 1;40(11):865-873. doi: 10.1097/EJA.0000000000001834. Epub 2023 May 3.
BACKGROUND
Up to 25% of trauma deaths are related to thoracic injuries.
OBJECTIVE
The primary goal was to analyse the incidence and time distribution of death in adult patients with major thoracic injuries. The secondary goal was to determine if potentially preventable deaths occurred within this time distribution and, if so, identify an associated therapeutic window.
DESIGN
Retrospective observational analysis.
SETTING
TraumaRegister DGU.
PATIENTS
Major thoracic injury was defined as an Abbreviated Injury Scale (AIS) 3 or greater. Patients with severe head injury (AIS ≥ 4) or injuries to other body regions with AIS being greater than the thoracic injury (AIS other >AIS thorax) were excluded to ensure that the most severe injury described was primarily thoracic related.
MAIN OUTCOME MEASURES
Incidence and time distribution of mortality were considered the primary outcome measures. Patient and clinical characteristics and resuscitative interventions were analysed in relation to the time distribution of death.
RESULTS
Among adult major trauma cases with direct admission from the accident scene, 45% had thoracic injuries and overall mortality was 9.3%. In those with major thoracic trauma ( n = 24 332) mortality was 5.9% ( n = 1437). About 25% of these deaths occurred within the first hour after admission and 48% within the first day. No peak in late mortality was seen. The highest incidences of hypoxia and shock were seen in non-survivors with immediate death within 1 h and early death (1 to 6 h). These groups received the largest number of resuscitative interventions. Haemorrhage was the leading cause of death in these groups, whereas organ failure was the leading cause of death amongst those who survived the first 6 h after admission.
CONCLUSION
About half of adult major trauma cases had thoracic injuries. In non-survivors with primarily major thoracic trauma, most deaths occurred immediately (<1h) or within the first 6 h after injury. Further research should analyse if improvements in trauma resuscitation performed within this time frame will reduce preventable deaths.
TRIAL REGISTRATION
The present study is reported within the publication guidelines of the TraumaRegister DGU® and registered as TR-DGU project ID 2020-022.
背景
多达 25%的创伤死亡与胸部损伤有关。
目的
主要目标是分析成人严重胸部损伤患者的死亡发生率和时间分布。次要目标是确定在此时间分布内是否发生了潜在可预防的死亡，如果是，确定相关的治疗窗口。
设计
回顾性观察性分析。
设置
创伤登记处 DGU。
患者
主要胸部损伤定义为损伤严重程度评分（Abbreviated Injury Scale，AIS）3 或更高。排除严重头部损伤（AIS≥4）或其他身体部位损伤 AIS 大于胸部损伤（AIS 其他>AIS 胸部）的患者，以确保描述的最严重损伤主要与胸部相关。
主要观察指标
死亡率的发生率和时间分布被认为是主要观察指标。分析患者和临床特征以及复苏干预与死亡时间分布的关系。
结果
在直接从事故现场入院的成年严重创伤患者中，45%有胸部损伤，总体死亡率为 9.3%。在有严重胸部创伤的患者（n=24332）中，死亡率为 5.9%（n=1437）。约 25%的死亡发生在入院后 1 小时内，48%发生在入院后 1 天内。没有看到晚期死亡率的高峰。在立即死亡 1 小时内和早期死亡（1 至 6 小时）的非幸存者中，缺氧和休克的发生率最高。这些组接受了最多的复苏干预。出血是这些组死亡的主要原因，而器官衰竭是在入院后 6 小时内存活的患者死亡的主要原因。
结论
大约一半的成年严重创伤患者有胸部损伤。在原发性严重胸部创伤的非幸存者中，大多数死亡发生在受伤后立即（<1 小时）或 6 小时内。进一步的研究应分析在此时间范围内进行的创伤复苏改进是否会减少可预防的死亡。
试验注册
本研究按照创伤登记处 DGU®的出版指南报告，并作为 TR-DGU 项目 ID 2020-022 进行注册。
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