Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes
Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes
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DOI：
10.1002/bjs.7705
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发表时间：
2012-01-01
影响因子：
9.6
通讯作者：
Goslings, J. C.
中科院分区：
文献类型：
--
作者：
Saltzherr, T. P.;Bakker, F. C.;Goslings, J. C.
背景：放射科受伤患者的计算机断层扫描 (CT) 需要潜在危险且耗时的患者运输和转移。据推测，在创伤室使用 CT 可以改善患者的治疗结果和工作流程。方法：一项随机试验比较了在荷兰两家创伤医院的创伤室与放射科放置 CT 扫描仪的效果。 16 岁以上的受伤患者在转运时被随机分配到其中一家医院。主要结果指标是随机分组后第一年内非住院天数。对多发性创伤或严重创伤性脑损伤 (TBI) 患者进行亚组分析。结果：纳入约 1124 名患者，其中 1045 名可用于分析。干预组的中位非住院天数为 360 天，而对照组为 362 天（P = 0.068）。干预组从到达到第一次 CT 成像的时间缩短了 13 分钟（36 分钟 vs 49 分钟；P < 0.001）。干预组的患者转运和运输减少了一半以上。对于多发性创伤（265 例患者）和 TBI（121 例）亚组，死亡率和出院天数的差异有利于干预组，但没有统计学意义。结论：位于创伤室的 CT 扫描仪减少了获取 CT 图像的时间并改进了工作流程，但并没有导致一般创伤人群的临床结果的实质性改善。观察到的对多发性创伤或严重 TBI 患者预后的有益影响并不具有统计学意义。注册号：ISRCTN55332315 (http://www.control-trials.com)。
Background: Computed tomography (CT) of injured patients in the radiology department requires potentially dangerous and time-consuming patient transports and transfers. It was hypothesized that CT in the trauma room would improve patient outcome and workflow.Methods: A randomized trial compared the effect of locating a CT scanner in the trauma room versus the radiology department in two Dutch trauma hospitals. Injured patients aged at least 16 years were assigned randomly to one of these hospitals at the time of transport. The primary outcome measure was the number of non-institutionalized days within the first year after randomization. Subgroup analyses were performed in patients with multiple trauma or severe traumatic brain injury (TBI).Results: Some 1124 patients were included, of whom 1045 were available for analysis. The median number of non-institutionalized days was 360 days in the intervention group versus 362 days for the control group (P = 0.068). The time from arrival to the first CT imaging was 13 min shorter in the intervention group (36 versus 49 min; P < 0.001). Patient transfers and transports were reduced by more than half in the intervention group. For both multiple trauma (265 patients) and TBI (121) subgroups, differences in mortality and out-of-hospital days favoured the intervention group, but were not statistically significant.Conclusion: A CT scanner located in the trauma room reduces the time to acquire CT images and improves workflow, but does not lead to substantial improvements in clinical outcomes in a general trauma population. Observed beneficial effects on outcomes in patients with multiple trauma or severe TBI were not statistically significant. Registration number: ISRCTN55332315 (http://www.controlled-trials.com).