国际旅行者中的伤害和医疗紧急情况。

Injuries and medical emergencies among international travellers.

机构信息

ISTM CTH (Certificate of Travel Health), Chemin des Croix-Rouges 12, Lausanne CH-1007, Switzerland.

Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland.

出版信息

J Travel Med. 2024 Jan 28;31(1). doi: 10.1093/jtm/taad088.

DOI:10.1093/jtm/taad088

PMID:37405992

Abstract

BACKGROUND

Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries and accidents that occur during travel are not emphasized enough in these settings.

METHODS

We performed a narrative review based on a literature search of PubMed, Google Scholar, UpToDate, DynaMed and LiSSa and on reference textbooks and medical journals dedicated to travel, emergency and wilderness medicine. Relevant secondary references were extracted. We also aimed to discuss newer or neglected issues, such as medical tourism, Coronavirus Disease 2019, exacerbations of co-morbidities associated with international travel, insurance coverage, health care seeking abroad, medical evacuation or repatriation and tips for different types of travellers' emergency medical kits (personal, group, physician handled).

RESULTS

All sources reviewed led to the selection of >170 references. Among epidemiological data on morbidity and deaths while abroad, only retrospective data are available. Deaths are estimated to occur in 1 in 100 000 travellers, with 40% caused by trauma and 60% by diseases, and <3% linked to infectious diseases. Trauma and other injuries acquired during travel, such as traffic accidents and drowning, can be reduced by up to 85% with simple preventive recommendations such as avoiding simultaneous alcohol intake. In-flight emergencies occur on 1 in 604 flights on average. Thrombosis risk is two to three times greater for travellers than for non-travellers. Fever during or after travel can occur in 2-4% of travellers, but in up to 25-30% in tertiary centres. Traveller's diarrhoea, although rarely severe, is the most common disease associated with travel. Autochthonous emergencies (acute appendicitis, ectopic pregnancy, dental abscess) can also occur.

CONCLUSIONS

Pre-travel medicine encounters must include the topic of injuries and medical emergencies, such as the risk-taking behaviours and foster better planning in a comprehensive approach along with vaccines and infectious diseases advices.

摘要

背景

热带传染病和可通过疫苗预防的紧急情况是旅行前咨询的主要内容。然而，在这些情况下，旅行期间发生的非传染性疾病、伤害和事故并没有得到足够的重视。

方法

我们进行了一项叙述性综述，检索了 PubMed、Google Scholar、UpToDate、DynaMed 和 LiSSa 中的文献，以及专门讨论旅行、急救和野外医学的参考书和医学期刊。提取了相关的次要参考文献。我们还旨在讨论一些较新或被忽视的问题，如医疗旅游、2019 年冠状病毒病、与国际旅行相关的合并症恶化、保险覆盖范围、在国外寻求医疗保健、医疗后送或遣返以及不同类型旅行者急救包（个人、团体、医生处理）的提示。

结果

所有审查的资料来源都选择了>170 篇参考文献。在国外发病率和死亡率的流行病学数据中，只有回顾性数据可用。据估计，每 100000 名旅行者中会有 1 人死亡，其中 40%是由创伤引起的，60%是由疾病引起的，<3%与传染病有关。通过避免同时摄入酒精等简单的预防建议，可以将旅行中发生的创伤和其他伤害（如交通事故和溺水）减少多达 85%。平均每 604 次航班中会发生 1 次机上紧急情况。与非旅行者相比，旅行者的血栓形成风险高出 2 至 3 倍。旅行期间或之后发烧可发生在 2-4%的旅行者中，但在 30%的三级中心中发生。旅行者腹泻虽然很少严重，但仍是与旅行相关的最常见疾病。还可能发生本地紧急情况（急性阑尾炎、异位妊娠、牙脓肿）。