An analysis of prehospital deaths: Who can we save?
An analysis of prehospital deaths: Who can we save?
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DOI：
10.1097/ta.0000000000000292
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发表时间：
2014-08-01
影响因子：
3.4
通讯作者：
Schulman, Carl I.
中科院分区：
文献类型：
--
作者：
Davis, James S.;Satahoo, Shevonne S.;Schulman, Carl I.
背景：自20世纪70年代末成立以来，创伤网络在院前环境中拯救了数千人的生命。然而，最近很少有工作对在现场死亡的患者进行评估。了解这些死亡的流行病学对于创伤系统的绩效评估和改进至关重要。我们假设可以确定特定的损伤类型并将其作为干预的目标。方法：回顾了一个大型城市县的法医报告，包括2011年未被送往医院的所有创伤死亡(即现场死亡)或到达时死亡。记录年龄、性别、死亡日期、发病机制和受伤情况。一个专家小组审查了每个病例，以确定主要死亡原因，以及患者的死亡是由潜在的可存活伤害还是不可存活的伤害造成的。结果：共纳入512名患者。患者80%为男性，主要死于钝性(53%)和穿透性(46%)原因，其中21%有自杀记录。主要死因是神经损伤(36%)，其次是出血(34%)、窒息(15%)和合并神经损伤/出血(15%)。损伤最多的解剖部位是大脑(59%)、胸部(54%)和腹部(35%)。最后，29%的患者死亡被归类为在目前的治疗方案下潜在的可存活损伤，主要是由于出血和胸部损伤。结论：在我们的研究人群中，超过五分之一的创伤死亡具有潜在的可存活损伤。在这一组中，胸部损伤和因出血死亡占主导地位，并为未来研究和实施新的院前干预措施提供了目标。此外，针对自杀预防的努力仍然非常重要。版权所有(C)2014年，Lippincott Williams&Wilkins
BACKGROUND: Since their inception in the late 1970s, trauma networks have saved thousands of lives in the prehospital setting. However, few recent works have been done to evaluate the patients who die in the field. Understanding the epidemiology of these deaths is crucial for trauma system performance evaluation and improvement. We hypothesized that specific patterns of injury could be identified and targeted for intervention.METHODS: Medical examiner reports in a large, urban county were reviewed including all trauma deaths during 2011 that were not transported to a hospital (i.e., died at the scene) or dead on arrival. Age, sex, date of death, mechanism, and list of injuries were recorded. An expert panel reviewed each case to determine the primary cause of death, and if the patient's death was caused by potentially survivable injuries or nonsurvivable injuries.RESULTS: A total of 512 patients were included. Patients were 80% male, died mostly of blunt (53%) and penetrating (46%) causes, and included 21% documented suicides. The leading cause of death was neurotrauma (36%), followed by hemorrhage (34%), asphyxia (15%), and combined neurotrauma/hemorrhage (15%). The anatomic regions most frequently injured were the brain (59%), chest (54%), and abdomen (35%). Finally, 29% of the patient deaths were classified as a result of potentially survivable injuries given current treatment options, mostly from hemorrhage and chest injuries.CONCLUSION: More than one of every five trauma deaths in our study population had potentially survivable injuries. In this group, chest injuries and death via hemorrhage were predominant and suggest targets for future research and implementation of novel prehospital interventions. In addition, efforts targeting suicide prevention remain of great importance. Copyright (C) 2014 by Lippincott Williams & Wilkins