目的地有影响吗？一项影响院前转运截止时间的政策变化后的结果。

Does destination make a difference? Outcomes after a policy change affecting cutoff times for prehospital transport.

机构信息

From the Division of Pediatric Surgery, Department of Surgery, Hasbro Children's Hospital (E.R., M.V.), and Warren Alpert Medical School at Brown University (O.C.); Lifespan Biostatistics, Epidemiology, Research Design, and Informatics Core (J.R.T.); and Division of Pediatric Surgery, Department of Surgery, Hasbro Children's Hospital (A.M.), Providence, Rhode Island.

出版信息

J Trauma Acute Care Surg. 2024 Sep 1;97(3):429-433. doi: 10.1097/TA.0000000000004245. Epub 2024 Jan 10.

DOI:10.1097/TA.0000000000004245

PMID:38197652

Abstract

BACKGROUND

Facilitating primary triage and care at pediatric trauma centers (PTCs) can improve outcomes for children after trauma. However, scene location and regional emergency medical services regulations may result in initial evaluation occurring at nonpediatric facilities with later transportation to PTCs for definitive care. In this study, we assessed the results of a change in transport time cutoff from 30 to 45 minutes on pediatric patient outcomes.

METHODS

After institutional review board approval, the Pediatric Trauma Database at a level 1 PTC was queried for patients seen before (January 1, 2015, to December 31, 2017) and after (January 1, 2018, to December 31, 2020) the implementation of a policy increasing transport cutoff time from 30 to 45 minutes. Patient outcomes were compared by transport status and Injury Severity Score (ISS) using generalized linear regression analysis.

RESULTS

A total of 505 patients were seen before policy changes, and 413 patients, after policy changes. Both groups had similar numbers of severely injured patients (ISS, ≥15; pre, 64 [13%]; post, 61 [15%]). Average transport time increased after change (pre, 20 minutes [95% confidence interval, 18-22 minutes]; post, 29 minutes [95% confidence interval, 26-33 minutes]; p = 0.0252), consistent with policy compliance. The proportion of transferred patients did not change after policy implementation ( p = 0.5856), and the complications among all patients with an ISS of ≥15 did not significantly decrease (pre, 75%; post, 65.6%). However, those patients with an ISS of ≥15 admitted directly from the scene had a lower frequency of complications after the policy changes (pre, 76%; post, 59%; p = 0.0319), and in the postperiod, transferred patients with an ISS of ≥15 had a higher complication rate than those admitted directly from the scene ( p < 0.0001).

CONCLUSION

Direct scene admission to a PTC is associated with a lower complication profile for patients with higher ISS. Methods to ensure adherence to cutoff thresholds for emergency medical services transport may have a positive benefit on patient outcomes.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

摘要

背景

在儿科创伤中心（PTC）进行初步分诊和护理可以改善创伤后儿童的预后。然而，现场位置和区域紧急医疗服务法规可能导致最初的评估在非儿科机构进行，然后将患者转运至 PTC 进行确定性治疗。在这项研究中，我们评估了将转运时间截止点从 30 分钟延长至 45 分钟对儿科患者结局的影响。

方法

在机构审查委员会批准后，对 1 级 PTC 的儿科创伤数据库进行了查询，以获取实施将转运时间截止点从 30 分钟延长至 45 分钟的政策之前（2015 年 1 月 1 日至 2017 年 12 月 31 日）和之后（2018 年 1 月 1 日至 2020 年 12 月 31 日）的患者数据。使用广义线性回归分析比较了转运状态和损伤严重度评分（ISS）的患者结局。

结果

共有 505 名患者在政策改变前接受治疗，413 名患者在政策改变后接受治疗。两组严重受伤患者的数量相似（ISS≥15；前组 64[13%]；后组 61[15%]）。改变后转运时间平均增加（前组 20 分钟[95%置信区间，18-22 分钟]；后组 29 分钟[95%置信区间，26-33 分钟]；p=0.0252），符合政策要求。政策实施后，转院患者的比例没有变化（p=0.5856），所有 ISS≥15 的患者的并发症发生率没有显著降低（前组 75%；后组 65.6%）。然而，ISS≥15 且直接从现场入院的患者在政策改变后并发症发生率较低（前组 76%；后组 59%；p=0.0319），在后一阶段，ISS≥15 且从现场直接转院的患者并发症发生率高于直接从现场入院的患者（p<0.0001）。