Bonatti J, Göschl O, Larcher P, Wödlinger R, Flora G
Department of Surgery I/University of Innsbruck School of Medicine, Austria.
Resuscitation. 1995 Oct;30(2):133-40. doi: 10.1016/0300-9572(95)00883-u.
The purpose of the present retrospective study was to identify easily obtainable predictors of short-term outcome for emergency victims treated by a physician-staffed helicopter emergency medical system (HEMS). The study was conducted at the HEMS unit 'Christophorus 1' based at Innsbruck, Austria. Outcomes for 2139 patients rescued in primary missions during a 3-year period from 1 January 1989 to 31 December 1991 were included in the study. The majority of missions were in response to sports accidents, although missions included a wide spectrum of emergencies. Data were obtained from the 'Christophorus 1' operation protocols and by written, personal, or telephone request from admitting hospitals. Eleven parameters selected from the HEMS flight logs were tested for their predictive value on survival following helicopter rescue. In a univariate analysis, the cause of the emergency, time at the scene, total duration of the emergency mission, patient age, patient gender, severity of the emergency using the National Advisory Committee of Aeronautics (NACA) scoring system, state of consciousness, respiratory status and patient circulatory status each had a statistically significant influence on survival up to 90 days following the emergency. Flight time to the scene and the original specialty of the additionally trained emergency physician had no significant influence on outcome. Multivariate analysis using the Cox proportional hazards model revealed that severity of the emergency by the seven-level NACA scale (P = 0.0001), initial respiratory status (P = 0.0001), time at the scene (P = 0.0108), patient age (P = 0.0047) and patient gender (P = 0.0477) were each independent predictors of short-term survival following physician-staffed helicopter rescue. We conclude that the parameters described above can be used in an initial predictive assessment by the flight physician and the admitting institution.
本回顾性研究的目的是确定由配备医生的直升机紧急医疗系统（HEMS）救治的急诊患者短期预后的易于获得的预测指标。该研究在奥地利因斯布鲁克的“克里斯托弗鲁斯1号”HEMS单位进行。研究纳入了1989年1月1日至1991年12月31日这3年期间在主要任务中获救的2139例患者。尽管任务包括各种各样的紧急情况，但大多数任务是应对体育事故。数据来自“克里斯托弗鲁斯1号”的操作协议，并通过向收治医院书面、亲自或电话请求获得。从HEMS飞行日志中选取的11个参数被测试其对直升机救援后生存的预测价值。在单变量分析中，紧急情况的原因、现场停留时间、紧急任务的总时长、患者年龄、患者性别、使用美国国家航空咨询委员会（NACA）评分系统的紧急情况严重程度、意识状态、呼吸状况和患者循环状况对紧急情况后90天内的生存均有统计学显著影响。到达现场的飞行时间和额外培训的急诊医生的原专业对预后无显著影响。使用Cox比例风险模型的多变量分析显示，七级NACA量表评估的紧急情况严重程度（P = 0.0001）、初始呼吸状况（P = 0.0001）、现场停留时间（P = 0.0108）、患者年龄（P = 0.0047）和患者性别（P = 0.0477）均是配备医生的直升机救援后短期生存的独立预测指标。我们得出结论，上述参数可由飞行医生和收治机构用于初始预测评估。
