{"title":"交通事故急诊病人的存活率及相关因素分析。","authors":"Thongpitak Huabbangyang, Rossakorn Klaiaungthong, Duangsamorn Jansanga, Airada Aintharasongkho, Tunwaporn Hanlakorn, Ratchanee Sakcharoen, Anucha Kamsom, Tavachai Soion","doi":"10.2147/OAEM.S344705","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Traffic accident patients place a tremendous burden on health care services because they require substantial, rapid, and effective evaluation, management, and treatment by emergency medical services (EMS) to decrease morbidity and mortality rates. This study investigated the 1-month survival rate and factors related to the survival of traffic accident patients managed by EMS.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed data of traffic accident patients serviced by the Surgico Medical Ambulance and Rescue Team (SMART) at Vajira Hospital, Bangkok, from January 1, 2018, to December 31, 2020. The data were collected from EMS patient care reports recorded using the emergency medical triage protocol as well as the criteria-based dispatch response codes in Thailand. Survival data at 1 month were obtained from electronic medical records.</p><p><strong>Results: </strong>Of the 340 traffic accident patients who fulfilled the study criteria, 314 (92.35%) were alive at 1 month. A multivariable analysis using multiple logistic regression identified prehospital level of consciousness, airway management, and cardiopulmonary resuscitation as factors associated with survival. Unresponsive patients had a lower survival rate than responsive patients (adjusted odds ratio [OR<sub>adj</sub>] = 0.16, 95% confidence interval [CI]: 0.05-0.56, p = 0.004). Prehospital airway management and cardiopulmonary resuscitation reduced the survival rate by 0.30 and 0.10 times, respectively (OR<sub>adj</sub> = 0.30, 95% CI: 0.09-0.97, p = 0.045 and OR<sub>adj</sub> = 0.10, 95% CI: 0.02-0.47, p = 0.004, respectively).</p><p><strong>Conclusion: </strong>Traffic accident patients had a high survival rate at 1 month. We identified three factors regarding EMS treatment which were related to increased survival: a prehospital responsive level of consciousness, no prehospital airway management, and no prehospital cardiopulmonary resuscitation. Therefore, the development of standard guidelines for the management of traffic accident patients by EMS is crucial to increase the survival rate of traffic accident patients.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"575-586"},"PeriodicalIF":0.0000,"publicationDate":"2021-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/3f/oaem-13-575.PMC8694573.pdf","citationCount":"1","resultStr":"{\"title\":\"Survival Rates and Factors Related to the Survival of Traffic Accident Patients Transported by Emergency Medical Services.\",\"authors\":\"Thongpitak Huabbangyang, Rossakorn Klaiaungthong, Duangsamorn Jansanga, Airada Aintharasongkho, Tunwaporn Hanlakorn, Ratchanee Sakcharoen, Anucha Kamsom, Tavachai Soion\",\"doi\":\"10.2147/OAEM.S344705\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Traffic accident patients place a tremendous burden on health care services because they require substantial, rapid, and effective evaluation, management, and treatment by emergency medical services (EMS) to decrease morbidity and mortality rates. This study investigated the 1-month survival rate and factors related to the survival of traffic accident patients managed by EMS.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed data of traffic accident patients serviced by the Surgico Medical Ambulance and Rescue Team (SMART) at Vajira Hospital, Bangkok, from January 1, 2018, to December 31, 2020. The data were collected from EMS patient care reports recorded using the emergency medical triage protocol as well as the criteria-based dispatch response codes in Thailand. Survival data at 1 month were obtained from electronic medical records.</p><p><strong>Results: </strong>Of the 340 traffic accident patients who fulfilled the study criteria, 314 (92.35%) were alive at 1 month. A multivariable analysis using multiple logistic regression identified prehospital level of consciousness, airway management, and cardiopulmonary resuscitation as factors associated with survival. Unresponsive patients had a lower survival rate than responsive patients (adjusted odds ratio [OR<sub>adj</sub>] = 0.16, 95% confidence interval [CI]: 0.05-0.56, p = 0.004). Prehospital airway management and cardiopulmonary resuscitation reduced the survival rate by 0.30 and 0.10 times, respectively (OR<sub>adj</sub> = 0.30, 95% CI: 0.09-0.97, p = 0.045 and OR<sub>adj</sub> = 0.10, 95% CI: 0.02-0.47, p = 0.004, respectively).</p><p><strong>Conclusion: </strong>Traffic accident patients had a high survival rate at 1 month. We identified three factors regarding EMS treatment which were related to increased survival: a prehospital responsive level of consciousness, no prehospital airway management, and no prehospital cardiopulmonary resuscitation. Therefore, the development of standard guidelines for the management of traffic accident patients by EMS is crucial to increase the survival rate of traffic accident patients.</p>\",\"PeriodicalId\":503614,\"journal\":{\"name\":\"Open Access Emergency Medicine : OAEM\",\"volume\":\"13 \",\"pages\":\"575-586\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-12-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/3f/oaem-13-575.PMC8694573.pdf\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Access Emergency Medicine : OAEM\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2147/OAEM.S344705\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Access Emergency Medicine : OAEM","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/OAEM.S344705","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
摘要
背景:交通事故患者需要紧急医疗服务(EMS)对其进行大量、快速、有效的评估、管理和治疗，以降低发病率和死亡率，给卫生保健服务带来了巨大的负担。本研究探讨EMS治疗交通事故患者的1个月生存率及影响生存率的相关因素。患者和方法:我们回顾性分析2018年1月1日至2020年12月31日曼谷Vajira医院外科医疗救护车和救援队(SMART)服务的交通事故患者的数据。数据收集自使用泰国紧急医疗分诊方案和基于标准的调度响应代码记录的EMS患者护理报告。1个月的生存数据来自电子病历。结果:340例符合研究标准的交通事故患者中，314例(92.35%)在1个月时存活。采用多元逻辑回归的多变量分析确定院前意识水平、气道管理和心肺复苏是与生存相关的因素。无应答患者的生存率低于应答患者(调整优势比[ORadj] = 0.16, 95%可信区间[CI]: 0.05-0.56, p = 0.004)。院前气道管理和心肺复苏分别使生存率降低0.30倍和0.10倍(ORadj = 0.30, 95% CI: 0.09-0.97, p = 0.045; ORadj = 0.10, 95% CI: 0.02-0.47, p = 0.004)。结论:交通事故患者1个月生存率高。我们确定了EMS治疗与提高生存率相关的三个因素:院前意识反应水平、院前气道管理和院前心肺复苏。因此，制定EMS对交通事故患者管理的标准指南对于提高交通事故患者的生存率至关重要。
Survival Rates and Factors Related to the Survival of Traffic Accident Patients Transported by Emergency Medical Services.
Background: Traffic accident patients place a tremendous burden on health care services because they require substantial, rapid, and effective evaluation, management, and treatment by emergency medical services (EMS) to decrease morbidity and mortality rates. This study investigated the 1-month survival rate and factors related to the survival of traffic accident patients managed by EMS.
Patients and methods: We retrospectively analyzed data of traffic accident patients serviced by the Surgico Medical Ambulance and Rescue Team (SMART) at Vajira Hospital, Bangkok, from January 1, 2018, to December 31, 2020. The data were collected from EMS patient care reports recorded using the emergency medical triage protocol as well as the criteria-based dispatch response codes in Thailand. Survival data at 1 month were obtained from electronic medical records.
Results: Of the 340 traffic accident patients who fulfilled the study criteria, 314 (92.35%) were alive at 1 month. A multivariable analysis using multiple logistic regression identified prehospital level of consciousness, airway management, and cardiopulmonary resuscitation as factors associated with survival. Unresponsive patients had a lower survival rate than responsive patients (adjusted odds ratio [ORadj] = 0.16, 95% confidence interval [CI]: 0.05-0.56, p = 0.004). Prehospital airway management and cardiopulmonary resuscitation reduced the survival rate by 0.30 and 0.10 times, respectively (ORadj = 0.30, 95% CI: 0.09-0.97, p = 0.045 and ORadj = 0.10, 95% CI: 0.02-0.47, p = 0.004, respectively).
Conclusion: Traffic accident patients had a high survival rate at 1 month. We identified three factors regarding EMS treatment which were related to increased survival: a prehospital responsive level of consciousness, no prehospital airway management, and no prehospital cardiopulmonary resuscitation. Therefore, the development of standard guidelines for the management of traffic accident patients by EMS is crucial to increase the survival rate of traffic accident patients.
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