The effect of a new in-hospital trauma care model on the outcomes of severely injured trauma patients in the emergency department: a retrospective observational study in China.
Qiu Zhao, Yue Zhao, Tingting Ke, Caili Lin, Yao Xu, Yuanyuan Xu, Shuli Liu, Xinqun Li
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引用次数: 0
Abstract
Background: The mortality and disability rates among severely injured trauma patients are very high. This study aimed to investigate whether a new in-hospital trauma care model can improve emergency care efficiency and enhance the prognosis of severely injured trauma patients.
Methods: This retrospective observational study included 366 severely injured trauma patients (ISS ≥ 16) who were admitted to the emergency department of a tertiary hospital between 2023 and 2024. Based on the emergency care model used, patients were divided into the traditional model group (n = 213) from January to April 2023 and the new model group (n = 153) from January to April 2024. The general clinical data, prognosis information, as well as seven emergency quality control indicators for both groups were collected and analyzed.
Results: The study included 270 male patients (73.8%) and 96 female patients (26.2%), with a mean age of 56 (44, 69) years. No significant differences were found between the two groups regarding gender, age, time since injury, mechanism of injury, and vital signs upon admission (P > 0.05). The new model group had significantly shorter times for establishing effective circulation access (15.66 ± 3.36 vs. 9.44 ± 3.18 min), establishing an artificial airway (36.90 ± 12.23 vs. 23.91 ± 9.07 min), preparing blood transfusion (48.84 ± 5.73 vs. 31.0 ± 64.67 min), completing whole-body CT scans (57.18 ± 8.26 vs. 42.17 ± 7.28 min), and developing a definitive treatment plan (77.45 ± 6.26 vs. 56.50 ± 6.35 min) compared to the traditional model group. Additionally, the new model group had a significantly higher rate of bedside FAST completion (92.8% vs. 53.1%) and a higher success rate of resuscitation within the first hour (70.9% vs. 85.0%) than the traditional model group. Regarding prognosis, the new model group had a lower overall in-hospital mortality rate (12.1% vs. 5.9%) and a lower incidence of complications such as DIC and ARDS (23.9% vs. 9.2%, all P < 0.05).
Conclusion: The new in-hospital trauma care model significantly enhanced the in-hospital emergency care efficiency, reduced in-hospital mortality, and decreased the incidence of complications for severely injured patients, which may serve as a useful reference for developing countries in similar settings.
背景：严重创伤患者的死亡率和致残率很高。本研究旨在探讨一种新的院内创伤护理模式是否能提高重症创伤患者的急诊护理效率和改善预后。方法：本回顾性观察研究纳入了2023 - 2024年间某三级医院急诊科收治的366例严重创伤患者（ISS≥16）。根据所采用的急诊模式，将患者分为传统模式组（n = 213）和新型模式组（n = 153），时间为2023年1月至2024年1月至4月。收集并分析两组患者的一般临床资料、预后信息及7项急救质量控制指标。结果：男性270例（73.8%），女性96例（26.2%），平均年龄56（44,69）岁。两组患者性别、年龄、损伤时间、损伤机制、入院生命体征差异无统计学意义（P < 0.05）。与传统模型组相比，新模型组建立有效循环通路（15.66±3.36 vs. 9.44±3.18 min）、建立人工气道（36.90±12.23 vs. 23.91±9.07 min）、准备输血（48.84±5.73 vs. 31.0±64.67 min）、完成全身CT扫描（57.18±8.26 vs. 42.17±7.28 min）、制定最终治疗方案（77.45±6.26 vs. 56.50±6.35 min）的时间均显著缩短。此外，新模型组床边FAST完成率（92.8%比53.1%）和1 h内复苏成功率（70.9%比85.0%）均显著高于传统模型组。在预后方面，新模式组总体住院死亡率较低（12.1% vs. 5.9%）， DIC、ARDS等并发症发生率较低（23.9% vs. 9.2%），均为P结论：新模式显著提高了院内急诊护理效率，降低了院内死亡率，降低了严重损伤患者的并发症发生率，可为类似情况的发展中国家提供有益的参考。临床试验号：不适用。
期刊介绍：
BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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