The influence of prehospital time on trauma patients outcome: A systematic review
The influence of prehospital time on trauma patients outcome: A systematic review
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DOI：
10.1016/j.injury.2015.01.008
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发表时间：
2015-04-01
影响因子：
2.5
通讯作者：
Bloemers, F. W.
中科院分区：
文献类型：
--
作者：
Harmsen, A. M. K.;Giannakopoulos, G. F.;Bloemers, F. W.
目的：时间被认为是创伤患者初始护理的重要决定因素。创伤护理的突出原则是“黄金时间”，即受伤后立即复苏和稳定被认为是最有益的时间。关于创伤患者的时间和运输，存在几种院前策略。文献显示，很少有经验知识的确切影响，院前时间创伤患者的结果。本研究的目的是系统地审查院前时间间隔和创伤patients.Methods的结果之间的相关性：一个系统的回顾，在MEDLINE，Embase和科克伦图书馆从成立到2014年5月19日进行。纳入了报告创伤患者的院前急救时间间隔（EMS）、结局参数和潜在混杂因素的研究。两名评审员收集数据，并使用STROBE工具评估结果和偏倚风险。主要结局是对死亡率的影响。结果：20篇III级证据的文章被认为符合本系统评价。结果表明，当反应时间或转移时间较短时，未分化创伤患者的死亡率降低。相反，增加现场时间和总院前时间与这一人群的生存几率增加有关。然而，快速运输似乎是有益的患者遭受穿透伤，特别是弥漫性穿透伤患者和患者与创伤性脑injuries.Conclusion：快速运输是有益的患者患有神经创伤和血流动力学不稳定的穿透伤患者。对于血流动力学稳定的未分化创伤患者，增加现场时间和总院前时间不会增加死亡率。对于未分化的创伤患者，重点应放在院前提供的护理类型，而不是快速运输。(C)2015爱思唯尔有限公司版权所有。
Objective: Time is considered an essential determinant in the initial care of trauma patients. Salient tenet of trauma care is the 'golden hour', the immediate time after injury when resuscitation and stabilization are perceived to be most beneficial. Several prehospital strategies exist regarding time and transport of trauma patients. Literature shows little empirical knowledge on the exact influence of prehospital times on trauma patient outcome. The objective of this study was to systematically review the correlation between prehospital time intervals and the outcome of trauma patients.Methods: A systematic review was performed in MEDLINE, Embase and the Cochrane Library from inception to May 19th, 2014. Studies reporting on prehospital time intervals for emergency medical services (EMS), outcome parameters and potential confounders for trauma patients were included. Two reviewers collected data and assessed the outcomes and risk of bias using the STROBE-tool. The primary outcome was the influence on mortality.Results: Twenty level III-evidence articles were considered eligible for this systematic review. Results demonstrate a decrease in odds of mortality for the undifferentiated trauma patient when response-time or transfer-time are shorter. On the contrary increased on-scene time and total prehospital time are associated with increased odds of survival for this population. Nevertheless rapid transport does seem beneficial for patients suffering penetrating trauma, in particular hypotensive penetratingly injured patients and patients with a traumatic brain injury.Conclusion: Swift transport is beneficial for patients suffering neurotrauma and the haemodynamically unstable penetratingly injured patient. For haemodynamically stable undifferentiated trauma patients, increased on-scene-time and total prehospital time does not increase odds of mortality. For undifferentiated trauma patients, focus should be on the type of care delivered prehospital and not on rapid transport. (C) 2015 Elsevier Ltd. All rights reserved.