Su E, Mann N C, McCall M, Hedges J R
Oregon Health Sciences University, School of Medicine, Portland, OR, USA.
Prehosp Emerg Care. 1997 Jul-Sep;1(3):123-7. doi: 10.1080/10903129708958803.
Retrospective, database analysis of major trauma cases.
1995 statewide trauma registry data for patients with EMT-P scene care.
The database included patient demographics, field vital signs, field procedures [e.g., intravenous (i.v.) line placement, chest compressions, needle thoracostomy, endotracheal intubation], field medication, and vital signs at ED presentation.
Patients aged < or = 12 years ("pediatric") were compared with those aged > 12 years ("older"). Analyses of patients with tachycardia, hypotension, and obtundation were performed using chi 2 analysis (alpha = 0.05).
Of 3,502 trauma patients managed by an EMT-P, only 297 (8%) were aged < or = 12 years. Fewer pediatric patients (18%) than adults (27%) had an injury severity scale score > or = 16, p < 0.005. The frequency of most resuscitation skills and the administration of medications were not statistically different between patient groups. However, i.v.s were four times more likely to be placed in adults (76%) than in pediatric patients (42%), p < 0.001. Subanalyses indicated fewer pediatric patients with tachycardia (p = 0.02) or hypotension (p = 0.02) received an i.v., compared with adults who had similar physiologic parameters. Obtunded patients were equally likely to receive endotracheal intubation, although the procedure was rarely used (20%).
EMT-Ps infrequently manage seriously injured children. i.v.s are less frequently placed in pediatric trauma patients, even in the setting of physiologic abnormalities. The contributions of these field procedures to patient outcomes should be evaluated further.
1）对全州范围内主要儿科创伤病例的发生频率以及护理人员（急诊医疗技术人员-paramedic，EMT-P）复苏技能的使用情况进行分析。2）确定EMT-P对受伤儿童使用复苏技能的频率是否低于对成年患者的使用频率。
对主要创伤病例进行回顾性数据库分析。
1995年全州创伤登记处中接受EMT-P现场护理患者的数据。
数据库包括患者人口统计学信息、现场生命体征、现场操作（如静脉输液管放置、胸外按压、针胸造口术、气管插管）、现场用药以及在急诊科就诊时的生命体征。
将年龄小于或等于12岁的患者（“儿科患者”）与年龄大于12岁的患者（“成年患者”）进行比较。使用卡方分析（α = 0.05）对心动过速、低血压和昏迷患者进行分析。
在由EMT-P处理的3502例创伤患者中，只有297例（8%）年龄小于或等于12岁。受伤严重程度评分大于或等于16的儿科患者（18%）少于成年患者（27%），p < 0.005。大多数复苏技能的使用频率和用药情况在两组患者之间无统计学差异。然而，成年患者（76%）接受静脉输液的可能性是儿科患者（42%）的四倍，p < 0.001。亚组分析表明，与具有相似生理参数的成年患者相比，心动过速（p = 0.02）或低血压（p = 0.02）的儿科患者接受静脉输液的较少。昏迷患者接受气管插管的可能性相同，尽管该操作很少使用（20%）。
EMT-P很少处理严重受伤的儿童。儿科创伤患者接受静脉输液的频率较低，即使在存在生理异常的情况下也是如此。应进一步评估这些现场操作对患者预后的影响。
