Kapadia Nazir Najeeb, Soomar Salman M, Afzal Badar, Siddiqui Emaduddin
Emergency Medicine Department, King Hamad University Hospital, Busaiteen, BHR.
Emergency Medicine Department, Aga Khan University, Karachi, PAK.
Cureus. 2024 Dec 11;16(12):e75564. doi: 10.7759/cureus.75564. eCollection 2024 Dec.
Road traffic injuries (RTIs) are currently the ninth most common cause of mortality and are expected to increase in the future. RTIs rank in the top three reasons why young people die. Because of the high incidence and mortality risk, proper trauma care has been prioritized for RTI patients who present to the emergency department. Making appropriate and prompt trauma emergency calls can save lives. Poor resource use and an increased burden of inquiry can result from the inappropriate development of trauma rush calls (TRCs). Therefore, this study aims to evaluate the appropriate generation of TRCs to manage patients with RTIs presenting to the emergency department (ED).
A retrospective analysis was conducted at the ED of the private tertiary care hospital in Karachi, Pakistan. Patients with RTIs and TRCs generated for the management were included. Dead on arrival was excluded. A total of 322 patients were enrolled using convenient sampling. A standard Performa was developed to collect the data from medical records, including demographics, clinical characteristics, radiological findings, TRC characteristics, and disposition. Multivariable logistic regression analysis was applied to determine the TRC justified using odds ratios, considering a p-value ≤0.05 as significant.
Of the total 322 patients, the majority were males (n=266, 82.61%) between 21 and 40 years of age. Most patients reported injury/accident through high-speed vehicle crash (n=102, 31.68%). A Glasgow Coma Scale (GCS) score of <14 was recorded in 119 (36.96%) patients, and of 208 patients, 153 (73.55%) had positive computed tomography (CT) head findings, majorly subdural hematoma (n=43, 28.10%). CT cervical spine showed fractures in 14 patients (11.29%). Only one patient had both a positive CT abdomen and focused assessment with sonography in trauma (FAST), with a low systolic blood pressure (SBP) of 85 mmHg, and the CT abdomen showed a grade 3 spleen laceration. TRC was justified in 248 (77.01%) patients. Multivariable analysis showed that a GCS <14 [adjusted odds ratio (aOR) 3.03 (95% CI: 2.58-5.04)] and cervical collar [aOR 3.12 (95% CI: 1.63-5.98)] were the significant predictors for the TRC justified.
A GCS <14 and cervical collar significantly justify the generation of TRC. These findings are crucial in educating ED staff regarding optimal care delivery. The future deployment of resources depends on these findings for skill development.
道路交通伤害（RTIs）目前是第九大常见死因，预计未来还会增加。RTIs在年轻人死亡原因中位列前三。由于其高发病率和死亡风险，对于前往急诊科就诊的RTIs患者，适当的创伤护理已被列为优先事项。及时拨打合适的创伤急救电话可以挽救生命。创伤急救电话（TRCs）制定不当可能导致资源利用不佳和问诊负担增加。因此，本研究旨在评估为管理前往急诊科（ED）就诊的RTIs患者而适当生成TRCs的情况。
在巴基斯坦卡拉奇一家私立三级护理医院的急诊科进行回顾性分析。纳入因RTIs并为管理而生成TRCs的患者。排除到达时已死亡的患者。采用方便抽样法共纳入322例患者。制定了一份标准表格，从病历中收集数据，包括人口统计学、临床特征、放射学检查结果、TRC特征和处置情况。应用多变量逻辑回归分析来确定合理的TRC，以比值比表示，将p值≤0.05视为有统计学意义。
在总共322例患者中，大多数为男性（n = 266，82.61%），年龄在21至40岁之间。大多数患者报告因高速车辆碰撞受伤/发生事故（n = 102，31.68%）。119例（36.96%）患者的格拉斯哥昏迷量表（GCS）评分<14，在208例患者中，153例（73.55%）头部计算机断层扫描（CT）检查结果为阳性，主要是硬膜下血肿（n = 43，28.10%）。CT颈椎检查显示14例患者（11.29%）有骨折。只有1例患者CT腹部检查阳性且创伤重点超声评估（FAST）阳性，收缩压（SBP）低至85 mmHg，CT腹部检查显示脾脏3级裂伤。248例（77.01%）患者的TRC是合理的。多变量分析显示，GCS<14 [调整后的比值比（aOR）3.03（95%置信区间：2.58 - 5.04）]和佩戴颈托 [aOR 3.12（95%置信区间：1.63 - 5.98）]是TRC合理的显著预测因素。
GCS<14和佩戴颈托显著表明TRC生成是合理的。这些发现对于培训急诊科工作人员提供最佳护理至关重要。未来资源的调配取决于这些用于技能发展的发现。
