瑞典使用直升机急救服务或公路救护车将创伤病人送往医院:生存率和入院前时间间隔的比较

Oscar Lapidus, Rebecka Rubenson Wahlin, Denise Bäckström
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摘要

关于直升机紧急医疗服务 (HEMS) 运送遭受重大创伤的成人的益处,研究结果不一,有些研究报告称,与常规紧急医疗服务 (EMS) 相比,直升机紧急医疗服务 (HEMS) 有助于生存。在瑞典创伤系统中,直升机急救服务的益处仍不明确。目的是调查瑞典由急救医疗系统运送的创伤患者的存活率和院前时间间隔与公路急救医疗系统的差异。瑞典创伤登记处(SweTrau)共登记了 74032 名在 2012-2022 年间接受治疗的创伤患者。主要结果是 30 天死亡率和出院(回家或康复)时的格拉斯哥结果评分;次要结果是抵达医院时触发创伤小组启动(TTA)的重伤患者比例和 GCS ≤ 8 的重伤患者院前气管插管比例。在研究期间,74032 名患者中有 4529 名由急救车运送。与急救中心转运的患者相比,急救中心转运的患者死亡率明显较低,分别为 1.9% vs 4.3%(ISS 9-15)、5.4% vs 9.4%(ISS 16-24)和 31% vs 42%(ISS ≥ 25)(P < 0.001)。急救车转运也与出院时神经系统预后较差、重伤患者院内 TTA 率较高、GCS ≤ 8 的重伤患者院前插管率较高有关。在所有伤势严重程度组别中,急救医疗队病人的院前时间间隔都明显长于急救医疗队。尽管院前时间间隔更长、受伤严重程度更高,但与急救医疗服务相比,由急救医疗服务送往医院的创伤患者死亡率明显更低。然而,这种生存优势可能是以更高程度的神经系统不良后果为代价的。在瑞典,运送严重受伤的创伤患者时,应考虑增加急救车的使用范围,使其覆盖所有地区,因为这可能是更可取的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals
The benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear. To investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS. A total of 74,032 trauma patients treated during 2012–2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation. 4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9–15), 5.4% vs 9.4% (ISS 16–24) and 31% vs 42% (ISS ≥ 25) (p < 0.001). Transport by HEMS was also associated with worse neurological outcome at discharge from hospital, as well as a higher rate of in-hospital TTA for severely injured patients and higher rate of prehospital intubation for severely injured patients with GCS ≤ 8. Prehospital time intervals were significantly longer for HEMS patients compared to EMS across all injury severity groups. Trauma patients transported to hospital by HEMS had significantly lower mortality compared to those transported by EMS, despite longer prehospital time intervals and greater injury severity. However, this survival benefit may have been at the expense of a higher degree of adverse neurological outcome. Increasing the availability of HEMS to include all regions should be considered as it may be the preferrable option for transport of severely injured trauma patients in Sweden.
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