Association between trauma triage and time-to-vaso-occlusive events in patients with sickle cell disease after traumatic injury: a retrospective study.
Association between trauma triage and time-to-vaso-occlusive events in patients with sickle cell disease after traumatic injury: a retrospective study.
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DOI：
10.1136/tsaco-2023-001200
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发表时间：
2023
影响因子：
2
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中科院分区：
文献类型：
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镰状细胞病(SCD)与血管闭塞事件(VOE)有关，可导致疾病并发症，包括早期死亡。鉴于VOE和创伤性损伤具有相似的炎症反应，SCD损伤患者可能容易发生急性并发症。这项研究首次研究创伤性损伤是否与未来VOES的严重程度增加有关。这项队列研究使用了宾夕法尼亚州西部SCD诊所的电子健康记录数据；通过回顾图表，确定了2000年1月至2021年7月期间的356名SCD患者。根据伤前和伤后1 年的连续病历数据，55名患者符合条件。根据创伤处理将患者分为三组：(1)既不对创伤团队激活(TTA)进行分诊，也不住院(提前出院)；(2)分诊但不住院(仅分诊)；(3)分诊和住院。结果包括从受伤到第一次VOE的时间，每年需要急诊科(ED)就诊的VOE计数，以及受伤后第一次VOE的ED住院时间(LOS)。早期出院的患者在受伤后2.93d内发生VOE事件，与分流和住院患者的52.375天和仅分流患者的100.16天相比，发生VOE的时间显著缩短(p=0.0058)。在所有组中，受伤后的年度VOE计数没有差异。然而，仅分流组在伤前(16.1h)至伤后(77.4h)的VOE LOS显著增加(p=0.038)。Cox回归模型显示，发生VOE事件的时间缩短与TTA状态的关系不大(p=0.06)。尽管创伤后VOE的长期结局变化很小，但在早期出院组中，创伤可能会加快VOE的发生时间。因此，未来的研究有必要分析创伤后分诊评估和干预的缺失是否会导致导致VOE结局的不可预见的生理性应激源。水平4：三个阴性标准的回顾性病例对照研究。
Sickle cell disease (SCD) is associated with vaso-occlusive events (VOEs) that can lead to disease complications, including early mortality. Given that similar inflammatory responses characterize VOE and traumatic injury, injured patients with SCD may be vulnerable to acute complications. This study is the first to examine whether traumatic injury is associated with increased severity of future VOEs. This cohort study was conducted using electronic health record data from an SCD clinic in Western Pennsylvania; 356 patients with SCD from January 2000 to July 2021 were identified via retrospective chart review. 55 patients were eligible based on continuous medical record data spanning 1 year preinjury and postinjury. Patients were sorted into three treatment groups based on injury management: (1) Neither triage to trauma team activation (TTA) nor inpatient admission (Early Discharge), (2) Triage but no inpatient admission (Triage Only), and (3) Triage and In-patient. Outcomes included time from injury to first VOE, annual VOE counts requiring an emergency department (ED) visit, and ED length of stay (LOS) for the first VOE after injury. Early Discharge individuals experienced a VOE event within 2.93 days of injury, significantly shorter time to event than Triage and In-patient individuals at 52.375 days and Triage Only individuals at 100.16 days (p=0.0058). No difference in annual VOE counts was noted postinjury across all groups. However, a significant increase in VOE LOS preinjury (16.1 hours) to postinjury (77.4 hours) was noted only for the Triage Only group (p=0.038). Cox regression model showed that shortened time to VOE events was marginally associated with TTA status (p=0.06). Despite minimal changes in long-term VOE outcomes after injury, traumatic injuries may accelerate the time-to-VOE among the Early Discharge group. Therefore, future research is warranted to analyze whether the absence of postinjury triage assessment and intervention may cause unforeseen physiologic stressors contributing to VOE outcomes. Level IV: retrospective case-control study with three negative criteria.
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影响因子：
3.7
作者：
Torres LS;Okumura JV;Silva DG;Mimura KK;Belini-Júnior É;Oliveira RG;Lobo CL;Oliani SM;Bonini-Domingos CR
通讯作者：
Bonini-Domingos CR
影响因子：
7.4
作者：
Jang T;Poplawska M;Cimpeanu E;Mo G;Dutta D;Lim SH
通讯作者：
Lim SH
影响因子：
2.7
作者：
Rosenbloom BN;Khan S;McCartney C;Katz J
通讯作者：
Katz J
影响因子：
28.5
作者：
Shao Y;Cheng Z;Li X;Chernaya V;Wang H;Yang XF
通讯作者：
Yang XF
DOI：
10.36469/jheor.2020.13348
发表时间：
2020-01-01
影响因子：
--
作者：
Kang, Hyeun Ah;Barner, Jamie C;Kutlar, Abdullah
通讯作者：
Kutlar, Abdullah