Predictive Effect of Out-of-Hospital Time in Outcomes of Severely Injured Young Adult and Elderly Patients
Predictive Effect of Out-of-Hospital Time in Outcomes of Severely Injured Young Adult and Elderly Patients
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DOI：
10.1017/s1049023x00004143
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发表时间：
2006-12-01
影响因子：
2.2
通讯作者：
Giraldez, Ediza M.
中科院分区：
文献类型：
--
作者：
Baez, Amado Alejandro;Lane, Peter L.;Giraldez, Ediza M.
简介：30年来，在受伤后的第一个小时内获得护理的重要性一直是创伤系统规划的基本原则。然而，这一信念的科学基础要么缺失，要么主要来自创伤中心的病例系列。本研究旨在确定院前时间和严重受伤的老年patients.Methods的结果之间的相关性：这是一个横断面，观察性研究。所有患有急性创伤的成年人（≥ 18岁）均包括在内，急性创伤定义为国际疾病分类第九版、临床修改诊断代码和E代码。排除了中毒、单系统烧伤和损伤的晚期效应。使用卡方和Student’s f检验进行显著性检验。为了评估院前时间和结果的预测效果，为年轻组和老年组构建了三个独立的logistic回归模型，住院时间，死亡率和并发症作为个体因变量。结果：在41，041例病例中，37，276例年龄>= 18岁。在1，866名受伤严重程度评分（ISS）> 15的人中，1，205名是年轻人，661名是老年人。Logistic回归分析结果显示，院前时间与住院时间显著相关（p = 0.001）和并发症（p = 0.016），但与年轻患者的死亡率无关（p = 0.264），而在老年患者中，院前时间对住院时间、并发症或死亡率没有显著的预测作用结论：本研究表明，年轻患者的院前时间与住院时间和并发症相关。在老年患者中，院前时间未能显示与任何测量结果的相关性。
Introduction: The importance of accessing care within the first hour after injury has been a fundamental tenet of trauma system planning for 30 years. However, the scientific basis for this belief either has been missing or largely derived from case series from trauma centers. This study sought to determine the correlation between prehospital times and outcomes among severely injured elderly patients.Methods: This is a cross-sectional, observational study. All adults (>= 18 years of age) with acute trauma as defined by The International Classification of Diseases Ninth Edition, Clinical Modification diagnostic codes and E-codes were included. Poisonings, single system burns, and late effects of injury were excluded. Chi-square and Student's f-test were used for significance testing. To assess the predictive effects of prehospital time and outcomes, three independent logistic regression models were constructed for both young and elderly groups, with hospital length of stay, mortality, and complications as individual dependent variables. Statistical significance was set at the 0.05 level.Results: Of 41,041 cases, 37,276 were >= 18 years of age. Of the 1,866 with an Injury Severity Score (ISS) > 15, 1,205 were young and 661 elderly. Logistic regression results showed that prehospital time correlated significantly with hospital length of stay (p = 0.001) and complications (p = 0.016), but not with mortality {p = 0.264) among young patients, whereas in the elderly group prehospital time had no significant predictive effect for length of stay, complications, or mortality (p = 0.512, p = 0.512, and p = 0.954 respectively).Conclusion: This population-based study has demonstrated that prehospital time correlates with length of stay and complications in young patients. In elderly patients, prehospital time failed to show correlation with any outcomes measured.