Koury S I, Moorer L, Stone C K, Stapczynski J S, Thomas S H
Department of Emergency Medicine, University of Kentucky College of Medicine, Lexington, USA.
Prehosp Emerg Care. 1998 Oct-Dec;2(4):289-92. doi: 10.1080/10903129808958882.
To study trauma patients requiring urgent operative interventions to determine whether transport mode was associated with outcome difference.
Eligible patients were injured adults and children who presented over a 57-month period to the emergency department (ED) at the study hospital (annual ED census 36,000) after air or ground transport from trauma scenes or referring hospitals. Patients included were those whose ED lengths of stay were <60 minutes prior to transfer to an operating room. Data collected included injury severity score (ISS), ED and hospital lengths of stay, and mortality. Continuous data, which were not distributed normally, were analyzed using Wilcoxon nonparametric analysis. Categorical variables were analyzed using chi-square testing. Multivariate logistic regression was used to account for confounding variables and isolate the effects of transport mode on mortality. Alpha for all tests was set at 0.05.
272 patients were eligible for study; 168 air medical and 104 ground transports. No between-group differences were found for ED length of stay, ISS, or mortality. A significantly longer hospital stay was found for air-transported patients. Subgroup analysis of patients with penetrating trauma and ISS of > or =25 revealed mortalities of 28% and 45% for air- and ground-transported patients, respectively; this difference was not statistically significant (p = 0.24), but the study had a power of only 22% to detect a difference at this magnitude.
This study failed to identify, but had insufficient power to rule out, outcome benefit to air medical transport in a subset of trauma patients requiring urgent operative interventions.
研究需要紧急手术干预的创伤患者，以确定转运方式是否与预后差异相关。
符合条件的患者为成年和儿童伤者，他们在57个月期间从创伤现场或转诊医院经空中或地面转运后，被送至研究医院的急诊科（急诊科年接诊量36000例）。纳入的患者为在转至手术室前急诊科停留时间<60分钟的患者。收集的数据包括损伤严重度评分（ISS）、急诊科和住院时间以及死亡率。对非正态分布的连续数据采用Wilcoxon非参数分析。分类变量采用卡方检验进行分析。多因素逻辑回归用于解释混杂变量，并分离转运方式对死亡率的影响。所有检验的α值设定为0.05。
272例患者符合研究条件；168例经空中医疗转运，104例经地面转运。在急诊科停留时间、ISS或死亡率方面未发现组间差异。发现空中转运患者的住院时间明显更长。对穿透性创伤且ISS≥25的患者进行亚组分析显示，空中和地面转运患者的死亡率分别为28%和45%；这种差异无统计学意义（p = 0.24），但该研究检测这种程度差异的效能仅为22%。
本研究未能确定，但也没有足够的效能排除，对于一部分需要紧急手术干预的创伤患者，空中医疗转运对预后有益。
