Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort.
Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort.
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DOI：
10.1016/j.annemergmed.2009.07.024
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发表时间：
2010-03
影响因子：
6.2
通讯作者：
Nichol, Graham
中科院分区：
文献类型：
--
作者：
Newgard, Craig D.;Schmicker, Robert H.;Hedges, Jerris R.;Trickett, John P.;Davis, Daniel P.;Bulger, Eileen M.;Aufderheide, Tom P.;Minei, Joseph P.;Hata, J. Steven;Gubler, K. Dean;Brown, Todd B.;Yelle, Jean-Denis;Bardarson, Berit;Nichol, Graham
医院外创伤发生后的第一个小时被称为“黄金时间”，但时间和结果之间的关系仍不清楚。我们评估了急诊医疗服务（EMS）的间隔时间和创伤患者的基于现场的生理异常的死亡率之间的关系。这是对2005年12月1日至2007年3月31日期间由146家EMS机构运送至北美10个地点的51家I级和II级创伤医院的成人（年龄≥15岁）创伤患者的院外前瞻性队列登记研究的次要分析。入选标准为收缩压小于或等于90 mm Hg，呼吸频率小于10次或大于29次/min，格拉斯哥昏迷量表评分小于或等于12，或进行了气道干预。结局为院内死亡率。我们用逻辑回归和2步工具变量模型评估EMS间期（激活、反应、现场、运输和总时间），并对基于场的混杂因素进行调整。有3，656例创伤患者可供分析，其中806例（22.0%）死亡。在多变量分析中，任何EMS间期的时间和死亡率之间均无显著相关性：（比值比[OR] 1.00; 95%置信区间[CI] 0.95 - 1.05），缓解（OR 1.00; 95% CI 9.97 - 1.04）、现场（OR 1.00; 95% CI 0.99 - 1.01）、运输（OR 1.00; 95% CI 0.98 - 1.01）或总EMS时间（OR 1.00; 95% CI 0.99 - 1.01）。亚组和工具变量分析并没有从质上改变这些结果。在这个北美的样本中，EMS间隔和现场生理异常的受伤患者的死亡率之间没有相关性。
The first hour after the onset of out-of-hospital traumatic injury is referred to as the “golden hour,” yet the relationship between time and outcome remains unclear. We evaluate the association between emergency medical services (EMS) intervals and mortality among trauma patients with field-based physiologic abnormality. This was a secondary analysis of an out-of-hospital, prospective cohort registry of adult (aged ≥15 years) trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007. Inclusion criteria were systolic blood pressure less than or equal to 90 mm Hg, respiratory rate less than 10 or greater than 29 breaths/min, Glasgow Coma Scale score less than or equal to 12, or advanced airway intervention. The outcome was inhospital mortality. We evaluated EMS intervals (activation, response, on-scene, transport, and total time) with logistic regression and 2-step instrumental variable models, adjusted for field-based confounders. There were 3,656 trauma patients available for analysis, of whom 806 (22.0%) died. In multivariable analyses, there was no significant association between time and mortality for any EMS interval: activation (odds ratio [OR] 1.00; 95% confidence interval [CI] 0.95 to 1.05), response (OR 1.00; 95% CI 9.97 to 1.04), on-scene (OR 1.00; 95% CI 0.99 to 1.01), transport (OR 1.00; 95% CI 0.98 to 1.01), or total EMS time (OR 1.00; 95% CI 0.99 to 1.01). Subgroup and instrumental variable analyses did not qualitatively change these findings. In this North American sample, there was no association between EMS intervals and mortality among injured patients with physiologic abnormality in the field.
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影响因子：
120.7
作者：
EISENBERG, MS;BERGNER, L;HALLSTROM, A
通讯作者：
HALLSTROM, A
影响因子：
9
作者：
Demetriades, D;Martin, M;Chan, L
通讯作者：
Chan, L
影响因子：
5.9
作者：
Becker, LR;Zaloshnja, E;Miller, TR
通讯作者：
Miller, TR
DOI：
10.1097/00005373-198206000-00001
发表时间：
1982-01-01
影响因子：
--
作者：
GERVIN, AS;FISCHER, RP
通讯作者：
FISCHER, RP
影响因子：
4.4
作者：
Lerner, EB;Moscati, RM
通讯作者：
Moscati, RM