Impact of helicopter transport and hospital level on mortality of polytrauma patients
Impact of helicopter transport and hospital level on mortality of polytrauma patients
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DOI：
10.1097/01.ta.0000061883.92194.50
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发表时间：
2004-01-01
影响因子：
--
通讯作者：
Zwipp, H
中科院分区：
文献类型：
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作者：
Biewener, A;Aschenbrenner, U;Zwipp, H
背景资料。尽管有许多研究分析了这一主题，但与地面救护车相比，直升机运送钝性多发伤患者的具体优势尚未明确确定。对德累斯顿直升机急救的403例多发伤患者(伤情严重程度评分[ISS]和GT；16)的4种可能路径进行了分析：HEM-UNI组(n=140)，经HEMS转至大学医院；AMB-REG组(n=102)，经地面救护车转至地区(二级或三级)医院；AMB-UNI组(n=70)，经地面救护车转至大学医院；和Intergroup(n=91)，经地面救护车转至地区医院，然后转至大学医院。使用的分数是国际空间站和国际空间站。用于统计分析的检验包括chi(2)和Fisher‘s检验。结果：年龄、性别和平均ISS(范围33.3-35.6)显示两组患者具有广泛的同质性。AMB-REG组的死亡率(41.2%)几乎是HEMS-UNI组(22.1%)的两倍(p=0.002)。AMB-UNI组病死率最低(15.7%，P=0.0 5)。TRISS分析(图表前)显示AMB-UNI和HEMS-UNI患者的结果相同。HEMS-UNI组、AMB-UNI组和AMB-REG组的抢救时间分别为90±29分钟、68±25分钟和69±26分钟。通过HEMS直接转送到I级创伤中心，可显著降低死亡率。原则上，这种益处可以归因于卓越的临床前治疗、首次进入I级创伤中心或两者兼而有之。然而，在这项研究和可比研究中，AMB-UNI组和HEMS-UNI组的相同存活率并不能证实通常由于更积极的现场方法而获得更好的存活率。
Background. Despite numerous studies analyzing this topic, specific advantages of helicopter transport of blunt polytrauma patients as compared with ground ambulances have not yet been identified unequivocally.Methods:. Four possible pathways in 403 polytrauma patients (Injury Severity Score [ISS] > 16) who were in reach of the helicopter emergency medical service (HEMS) Dresden were analyzed as follows: HEMS-UNI group (n = 140), transfer by HEMS into a university hospital; AMB-REG group (n = 102), transfer by ground ambulance into a regional (Level II or III) hospital; AMB-UNI group (n = 70), transfer by ground ambulance into the university hospital; and INTER group (n = 91), transfer by ground ambulance into a regional hospital, followed by transfer to the university hospital. Scores used were the ISS and the TRISS. Tests used for statistical analysis included chi(2) and Fisher's tests. Statistical significance was set at p > 0.05.Results: Age, gender, and mean ISS (range, 33.3-35.6) revealed extensive homogeneity of the groups. Mortality of the AMB-REG group was almost doubled (41.2%) compared with HEMS-UNI (22.1%) patients (p = 0.002). The AMB-UNI group displayed the lowest mortality (15.7%, p = not significant). TRISS analysis (PRE-Chart) revealed identical outcome for AMB-UNI and HEMS-UNI patients. Rescue time averaged 90 +/- 29 minutes for HEMS-UNI patients, 68 +/- 25 minutes for AMB-UNI patients, and 69 +/- 26 minutes for the AMB-REG group.Conclusion. Primary transfer by HEMS into a Level I trauma center reduces mortality markedly. In principle, this benefit can be attributed to superior preclinical therapy, primary admission to a Level I trauma center, or both. However, the identical probability of survival of the AMB-UNI and HEMS-UNI groups in this and comparable studies does not confirm generally better survival rates on account of a more aggressive on-site approach.