Taylor Zachary, McCague Andrew
Medicine, College of Osteopathic Medicine of the Pacific - Northwest, Western University of Health Sciences, Lebanon, USA.
General Surgery, Desert Regional Medical Center, Palm Springs, USA.
Cureus. 2024 Apr 11;16(4):e58070. doi: 10.7759/cureus.58070. eCollection 2024 Apr.
Introduction This research aims to investigate the role of time since trauma (TST) in refining trauma team activation (TTA) criteria within a level I trauma center. We analyze the association between TST and post-emergency department (ED) disposition, proposing new insights for the enhancement of TTA criteria. Methods A retrospective analysis was conducted on a dataset comprising 3,693 patients presenting to a level I trauma center following motor vehicle accidents (MVAs) from 2016 to 2021. Data from a trauma registry, encompassing time of injury, time of ED arrival, TTA status, and post-ED disposition, were utilized. TST was calculated as the difference between the time of injury and the time of ED arrival. Patients that received TTA, full or partial, were categorized based on TST (less than one hour, one to two hours, and two or more hours). Statistical analyses, including chi-square tests, were performed using the Statistical Analysis System (SAS) (version 3.8, SAS Institute Inc., Cary, NC). Results Of the 1,261 patients meeting the criteria, 98.3% received TTA, with decreasing TTA rates observed with increasing TST (p = 0.0076). A significant association was found between TST and post-ED disposition for patients who received TTA (p = 0.0007). Compared to the other TST groups, a higher proportion of patients with a TST of two or more hours were admitted, sent to the intensive care unit (ICU), and sent to the operating room (OR). Conclusion The study indicates a statistically significant relationship between TST and TTA rates, challenging our assumptions about the decreased need for TTA over time. While a longer TST was associated with a lower percentage of TTA, patients with a TST of two or more hours demonstrated increased rates of admission, ICU utilization, and surgical interventions. This suggests that TTA criteria may benefit from refinement to include patients with longer TST. Acknowledging study limitations, such as a small sample size and retrospective design, this research contributes valuable insights into potential considerations for optimizing trauma care protocols.
引言 本研究旨在探讨创伤后时间（TST）在一级创伤中心完善创伤团队启动（TTA）标准中的作用。我们分析了TST与急诊科（ED）出院处置之间的关联，为改进TTA标准提供新的见解。方法 对2016年至2021年期间因机动车事故（MVA）到一级创伤中心就诊的3693例患者的数据集进行回顾性分析。利用创伤登记处的数据，包括受伤时间、ED到达时间、TTA状态和ED出院处置情况。TST计算为受伤时间与ED到达时间之间的差值。接受全部或部分TTA的患者根据TST进行分类（少于1小时、1至2小时和2小时或更长时间）。使用统计分析系统（SAS）（版本3.8，SAS Institute Inc.，北卡罗来纳州卡里）进行统计分析，包括卡方检验。结果 在符合标准的1261例患者中，98.3%接受了TTA，随着TST增加，TTA率下降（p = 0.0076）。在接受TTA的患者中，发现TST与ED出院处置之间存在显著关联（p = 0.0007）。与其他TST组相比，TST为2小时或更长时间的患者中，更高比例的患者被收治、送入重症监护病房（ICU）和送入手术室（OR）。结论 该研究表明TST与TTA率之间存在统计学上的显著关系，挑战了我们关于随着时间推移TTA需求减少的假设。虽然较长的TST与较低的TTA百分比相关，但TST为2小时或更长时间的患者入院率、ICU使用率和手术干预率增加。这表明TTA标准可能受益于改进，以纳入TST较长的患者。认识到研究的局限性，如样本量小和回顾性设计，本研究为优化创伤护理方案的潜在考虑因素提供了有价值的见解。
