地理空间和时间因素与重大创伤院前应对之间的关联:英格兰北部的一项回顾性队列研究

Ryan D McHenry, Christopher A Smith
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摘要

在全球范围内,重大创伤是导致过早死亡和残疾的主要原因,许多医疗保健系统都希望通过提供院前重症监护来改善严重创伤后的治疗效果。许多研究都集中在院前重症监护和先进的院前干预措施的疗效上,但对于院前重症监护服务的结构如何影响对重大创伤的响应却知之甚少。本研究评估了重大创伤中院前重症监护响应的可能性与这些服务的规划和发展中的重要因素(地理隔离、一天中的时间和任务机制)之间的关联。当地的创伤登记处利用创伤审计与研究网络(Trauma Audit and Research Network)的数据以及有关院前管理的其他信息,确定了英格兰北部主要创伤中心收治的重大创伤患者。提取的数据包括事发地点和时间、受伤机制、现场时间以及是否有院前重症监护团队。绘制了地区主要创伤中心 30 分钟间隔等时线图,确定了地理隔离情况。单变量逻辑回归比较了院前重症监护响应与传统救护车响应在不同程度的地理隔离、白天或夜间以及受伤机制下的可能性,多元线性回归评估了地理隔离、服务响应和现场时间之间的关联。共纳入了 2619 起事故,其中 23.3% 由院前重症监护团队负责。与传统救护车服务相比,院前重症监护团队更有可能对地理位置较为偏僻地区的重大创伤事件做出响应(OR 1.42,95% CI 1.30-1.55,p < 0.005)。在受伤机制方面存在明显差异,而在昼夜响应方面则没有明显差异。院前重症监护团队的响应和地理位置的日益偏远与较长的现场时间有关(p < 0.005)。在地理位置较为偏僻的地区,院前重症监护团队更有可能对重大创伤做出响应。在为重伤患者提供高级干预和转运服务时,加强院前护理可减轻地理位置上的不平等。在靠近大医院的地区,院前重症护理响应的需求可能尚未得到满足。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The association between geospatial and temporal factors and pre-hospital response to major trauma: a retrospective cohort study in the North of England
Major trauma is a leading cause of premature death and disability worldwide, and many healthcare systems seek to improve outcomes following severe injury with provision of pre-hospital critical care. Much research has focussed on the efficacy of pre-hospital critical care and advanced pre-hospital interventions, but less is known about how the structure of pre-hospital critical care services may influence response to major trauma. This study assessed the association between likelihood of pre-hospital critical care response in major trauma and factors important in the planning and development of those services: geographic isolation, time of day, and tasking mechanism. A local trauma registry, supported with data from the Trauma Audit and Research Network alongside additional information regarding pre-hospital management, identified patients sustaining major trauma admitted to Major Trauma Centres in the North of England. Data was extracted on location and time of incident, mechanism of injury, on-scene times, and presence or absence of pre-hospital critical care team. An isochrone map was constructed for 30-minute intervals to regional Major Trauma Centres, defining geographic isolation. Univariate logistic regression compared likelihood of pre-hospital critical care response to that of conventional ambulance response for varying degrees of geographic isolation, day or night period, and mechanism of injury, and multiple linear regression assessed the association between geographic isolation, service response and on-scene time. 2619 incidents were included, with 23.3% attended by pre-hospital critical care teams. Compared to conventional ambulance services, pre-hospital critical care teams were more likely to respond major trauma in areas of greater geographic isolation (OR 1.42, 95% CI 1.30–1.55, p < 0.005). There were significant differences in the mechanism of injury attended and no significant difference in response by day or night period. Pre-hospital critical care team response and increasing geographic isolation was associated with longer on-scene times (p < 0.005). Pre-hospital critical care teams are more likely to respond to major trauma in areas of greater geographic isolation. Enhanced pre-hospital care may mitigate geographic inequalities when providing advanced interventions and transport of severely injured patients. There may be an unmet need for pre-hospital critical care response in areas close to major hospitals.
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