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首页> 外文期刊>Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine >Identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study
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Identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study

机译：在区域性创伤网络中识别与主要创伤患者结局相关的院前因素：一项探索性研究

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Background Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for adults aged less than 45?years old. This study aimed to identify pre-hospital factors associated with patient outcomes for major trauma within one Regional Trauma Network. Method Secondary analysis of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (TARN) was undertaken. The primary outcome used in analysis was ‘Status at Discharge’ (alive/deceased). Independent variables considered included ‘Casualty Characteristics’ such as mechanism of injury (MOI), age, and physiological measurements, as well as ‘Response Characteristics’ such as response timings and skill mix. Binary Logistic Regression analysis using the ‘forward stepwise’ method was undertaken for physiological measures taken at the scene. Results The study analysed 1033 major trauma records (mean age of 38.5?years, SD 21.5, 95% CI 37–40). Adults comprised 82.6% of the sample ( n =?853), whilst 12.9% of the sample were children ( n =?133). Men comprised 68.5% of the sample ( n =?708) in comparison to 28.8% women ( n =?298). Glasgow Coma Score (GCS) ( p p p Isolated bivariate associations provided tentative support for response characteristics such as existing dispatching practices and the value of rapid crew arrival. However, these measurements appear to be of limited utility in predictive modelling of outcomes. Discussion The complexity of physiological indices potentially complicate their predictive utility e.g. whilst a Systolic Blood Pressure (SBP) of Analysis suggested that as people age, outcomes from major trauma significantly worsened. This finding is consistent with existing research highlighting the relationship between trauma in elderly patients and poorer outcomes. Conclusion Findings lend further validity to GCS, Respiration Rate and Age as predictive triggers for transport to a Major Trauma Centre. Analysis of interactions between response times, skill mix and triage demand further exploration but tentatively support the ‘Golden Hour’ concept and suggest a potential ‘load and go and play on the way’ approach.
机译：背景技术在英国（UK），年龄小于45岁的成年人通常遭受严重的生命威胁，并且是主要的死亡原因。这项研究的目的是在一个区域性创伤网络内确定与严重创伤患者预后相关的院前因素。方法对创伤检查研究网络（TARN）进行的院前检查数据和患者结果数据进行二次分析。分析中使用的主要结果是“出院状态”（活跃/死亡）。考虑的独立变量包括“伤亡特征”（例如伤害机制（MOI），年龄和生理测量）以及“响应特征”，例如响应时间和技能组合。针对现场采取的生理措施，使用“前进逐步”方法进行了二元Logistic回归分析。结果该研究分析了1033例重大创伤记录（平均年龄38.5岁，SD 21.5，95％CI 37-40）。成人占样本的82.6％（n = 853），而样本的12.9％是儿童（n = 133）。男性占样本的68.5％（n = 708），而女性则为28.8％（n = 298）。格拉斯哥昏迷评分（GCS）（ppp）孤立的双变量关联为响应特征（例如现有调度实践和机组人员快速到达的价值）提供了初步支持，但是，这些度量似乎在结果的预测建模中用途有限。生理指标可能会使它们的预测效用复杂化，例如，收缩压分析法（SBP）提示，随着人的年龄增长，重大创伤的后果显着恶化，这一发现与现有研究一致，该研究强调了老年患者创伤与不良后果之间的关系。结论研究结果进一步证实了GCS，呼吸频率和年龄是转移到主要创伤中心的预测触发因素，分析响应时间，技能组合和分类之间的相互作用需要进一步探索，但初步支持“黄金时段”的概念并提出了潜在的可能性'加载并继续播放方式。

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