Burney R E, Hubert D, Passini L, Maio R
Department of Surgery, University of Michigan, Ann Arbor.
Ann Emerg Med. 1995 Feb;25(2):187-92. doi: 10.1016/s0196-0644(95)70322-5.
In a previous 1-year retrospective study, we found no differences in outcomes of patients transported by physician/nurse (P/N) and nurse/nurse (N/N) air medical crews. To confirm this finding and to identify any trends in outcome that might be associated with changes in crew composition, we prospectively collected and analyzed 2 additional years of severity and outcome data.
Prospective cohort.
University hospital-based air medical program.
Severity measured by APACHE-II, the Revised Trauma Score, and the Therapeutic Intervention Scoring System, and outcomes measured by mortality and the number of ICU and hospital days, were gathered prospectively on all adult air medical patients between July 1, 1990, and June 30, 1992. Patients less than 16 years old or those who were delivered to other hospitals were excluded. Patients were categorized as cardiac, acute trauma, and other. Origin of transfer and transfer times were included in the analysis. In all, 1,169 patients were studied--554 in the first year of the study, 615 in the second. In the first year, there were 185 P/N (33%) and 369 N/N (67%) flights. P/N patients were older (48.8 versus 44.5 years; P = .01) and were more likely to come from a scene (14% versus 5.7%; P = .001), but no differences were found with regard to sex or disease category. Mortality, the Therapeutic Intervention Scoring System, APACHE-II, number of ICU days, and number of hospital days were no different; nor were total flight times or times spent at the hospital or scene. In the second year, 89% of flights were N/N. Differences in age or origin were not observed. Severity levels and outcomes remained unchanged. Between 1987 and 1992, the proportion of cardiac patients decreased, and overall illness severity of transported patients increased.
Two years of detailed prospective measurement of air medical patient characteristics and outcomes confirmed the initial finding that no significant differences in clinical outcomes could be identified between patients managed by P/N versus N/N crews.
在之前一项为期1年的回顾性研究中，我们发现由医生/护士（P/N）和护士/护士（N/N）空中医疗机组转运的患者，其结局并无差异。为证实这一发现，并确定可能与机组人员构成变化相关的任何结局趋势，我们前瞻性地收集并分析了另外两年的严重程度和结局数据。
前瞻性队列研究。
大学附属医院空中医疗项目。
前瞻性收集了1990年7月1日至1992年6月30日期间所有成年空中医疗患者的以下数据：用急性生理与慢性健康状况评分系统（APACHE-II）、修订创伤评分和治疗干预评分系统衡量的严重程度，以及用死亡率、重症监护病房（ICU）天数和住院天数衡量的结局。排除了年龄小于16岁或被转运至其他医院的患者。患者分为心脏疾病、急性创伤和其他类别。分析纳入了转运起点和转运时间。总共研究了1169例患者，研究第一年554例，第二年615例。第一年，有185次P/N（33%）飞行和369次N/N（67%）飞行。P/N组患者年龄更大（48.8岁对44.5岁；P = 0.01），且更有可能来自现场（14%对5.7%；P = 0.001），但在性别或疾病类别方面未发现差异。死亡率、治疗干预评分系统、APACHE-II、ICU天数和住院天数均无差异；总飞行时间、在医院或现场花费的时间也无差异。第二年，89%的飞行是N/N。未观察到年龄或转运起点的差异。严重程度水平和结局保持不变。1987年至1992年期间，心脏疾病患者的比例下降，转运患者的总体疾病严重程度增加。
对空中医疗患者特征和结局进行的两年详细前瞻性测量，证实了最初的发现，即由P/N机组和N/N机组管理的患者在临床结局上无显著差异。
