Suominen P, Baillie C, Kivioja A, Korpela R, Rintala R, Silfvast T, Olkkola K T
Department of Anaesthesia, University of Helsinki, Finland.
J Pediatr Surg. 1998 Sep;33(9):1388-92. doi: 10.1016/s0022-3468(98)90014-8.
The aim of this study was to compare the outcome of severe blunt trauma in children receiving prehospital care from either physician-staffed advanced life support (ALS) units, or from basic life support (BLS) units staffed by emergency medical technicians.
The records of 288 children with severe blunt trauma who required intensive care in the regional level 1 trauma center or who died from their injuries were analyzed retrospectively. Patients were excluded if resuscitation at the scene was not attempted, if the level of prehospital care was unspecified, or if arrival at the level 1 trauma center was delayed beyond 150 minutes. Seventy-two patients met the inclusion criteria of BLS-, and 49 the criteria of ALS-prehospital care.
A reduced mortality rate (22.4% v 31.9%) was seen in the ALS group, which was more apparent in a "salvageable but high-risk" subgroup, characterized by Glasgow Coma of Scale 4 through 8, Pediatric Trauma Score of 0 through 5, and Injury Severity Score (ISS) of 25 through 49. However, a statistically significant difference was only seen when trauma severity was evaluated by the ISS.
An improved outcome in children with severe blunt trauma has been demonstrated when prehospital care is provided by physician-staffed ALS units compared with BLS units.
本研究旨在比较由配备医生的高级生命支持（ALS）小组或由急救医疗技术人员配备的基础生命支持（BLS）小组在院前对严重钝性创伤儿童进行救治的效果。
回顾性分析了288例在地区一级创伤中心需要重症监护或因伤死亡的严重钝性创伤儿童的记录。如果未在现场尝试进行复苏、院前护理水平未明确指定或到达一级创伤中心的时间延迟超过150分钟，则将患者排除。72例患者符合BLS院前护理的纳入标准，49例符合ALS院前护理的标准。
ALS组的死亡率降低（22.4%对31.9%），在以格拉斯哥昏迷量表评分为4至8、小儿创伤评分为0至5以及损伤严重度评分（ISS）为25至49为特征的“可挽救但高风险”亚组中更为明显。然而，仅在通过ISS评估创伤严重程度时才观察到统计学上的显著差异。
与BLS小组相比，由配备医生的ALS小组提供院前护理时，严重钝性创伤儿童的治疗效果得到了改善。
