Young J S, Bassam D, Cephas G A, Brady W J, Butler K, Pomphrey M
University of Virginia Trauma Center, Department of Surgery, Charlottesville 22906-0005, USA.
Am Surg. 1998 Jan;64(1):88-91; discussion 91-2.
The purpose of organized trauma systems is to ensure the expeditious transfer of seriously injured patients to the facility best equipped to care for their injuries. Patients are referred to our trauma center, either by ambulance or helicopter, directly from the scene or through interhospital transfer. We examined the difference in outcome between those patients sent directly to the trauma center versus those seen at other hospitals and subsequently referred to the trauma center. Our hypothesis was that a delay at the referring hospital is detrimental to patient outcome. Adult trauma patients with Injury Severity Scores > 15, treated over 16 months from July 1, 1994, to October 31, 1995, were studied. Patients who survived 24 hours experienced significantly shorter intensive care unit (14 vs 10 days; P < 0.05) and hospital (21 vs 16 days; P < 0.05) lengths of stay when taken directly to the trauma center. In addition, there were significantly fewer deaths in patients with a probability of survival > 0.5 and a slightly lower overall mortality in those patients who survived at least 1 day. This study demonstrates that patients with major trauma taken directly to the trauma center had shorter hospital and intensive care unit stays and lower mortality. The study supports the paradigm that, when possible, major trauma patients should be sent to trauma centers directly from the injury scene.
有组织的创伤系统的目的是确保将重伤患者迅速转运至最有能力治疗其损伤的医疗机构。患者通过救护车或直升机，直接从现场或通过医院间转运被转诊至我们的创伤中心。我们研究了直接被送往创伤中心的患者与先在其他医院就诊随后被转诊至创伤中心的患者在治疗结果上的差异。我们的假设是，转诊医院的延误对患者的治疗结果不利。对1994年7月1日至1995年10月31日期间接受治疗的损伤严重度评分>15的成年创伤患者进行了研究。存活24小时的患者，直接被送往创伤中心时，其重症监护病房住院时间（14天对10天；P<0.05）和住院时间（21天对16天；P<0.05）显著缩短。此外，存活概率>0.5的患者死亡人数显著减少，至少存活1天的患者总体死亡率略低。这项研究表明，直接被送往创伤中心的严重创伤患者住院时间和重症监护病房住院时间较短，死亡率较低。该研究支持这样一种模式，即只要有可能，严重创伤患者应从受伤现场直接被送往创伤中心。
