Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients.
Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients.
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DOI：
10.1186/cc12796
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发表时间：
2013-06-21
期刊：
影响因子：
--
通讯作者：
Hildebrand F
中科院分区：
文献类型：
--
作者：
Andruszkow H;Lefering R;Frink M;Mommsen P;Zeckey C;Rahe K;Krettek C;Hildebrand F
由医生组成的直升机紧急医疗服务 (HEMS) 是德国院前创伤护理的一个成熟组成部分。减少救援时间和增加服务面积可能是 HEMS 的具体优势。相比之下，HEMS 的可用性与高昂的财务负担有关，并且取决于天气、白天时间和受控目视飞行规则。迄今为止，关于 HEMS 在改善临床结果方面的有益作用的明确证据仍然难以捉摸。使用德国创伤外科学会的 TraumaRegister DGU® 对 2007 年至 2009 年间主要接受 HEMS 或地面紧急医疗服务 (GEMS) 治疗的创伤患者（伤害严重程度评分；ISS ≥9）进行了分析。仅纳入在德国 I 级和 II 级创伤中心接受治疗且具有有关交通方式的完整数据的患者。根据美国胸科医师学会/重症监护医学会（ACCP/SCCM）共识会议委员会的标准和序贯器官衰竭评估（SOFA）评分，住院治疗期间的并发症包括败血症和器官衰竭。本研究共纳入 13,220 名外伤患者。其中，62.3% (n = 8,231) 通过 GEMS 运输，37.7% (n = 4,989) 通过 HEMS 运输。与 GEMS 相比，HEMS 治疗的患者损伤更严重（ISS 26.0 vs. 23.7，P < 0.001），胸部和腹部损伤更严重。 HEMS 中的现场医疗治疗范围更广泛，包括插管、胸腔治疗和升压药治疗 (P < 0.001)，导致现场时间延长（39.5 分钟 vs. 28.9 分钟，P < 0.001）。在临床过程中，HEMS 患者更频繁地出现多器官功能障碍综合征 (MODS)（HEMS：33.4% vs. GEMS：25.0%；P < 0.001）和脓毒症（HEMS：8.9% vs. GEMS：6.6%，P < 0.001），导致 ICU 治疗时间和住院时间增加（P < 0.001）。多变量逻辑回归分析发现，经过 11 个其他变量调整后，HEMS 死亡率的比值比为 0.75（95% CI：0.636 至 862）。随后，对白天转运至一级创伤中心的患者进行了亚组分析，目的是调查创伤治疗中心的级别与创伤后结果之间可能存在的相关性。根据该分析，采用创伤评分和伤害严重程度评分 (TRISS) 方法（HEMS：0.647 对比 GEMS：0.815；P = 0.002）以及修订伤害严重程度分类 (RISC) 评分（HEMS：0.772 对比 GEMS：0.864；P = 0.002）后，标准化死亡率 (SMR) 显着降低0.045）在 HEMS 组中。尽管 HEMS 患者受伤更严重，MODS 和败血症的发生率明显更高，但与 GEMS 相比，这些患者表现出生存优势。
Physician-staffed helicopter emergency medical services (HEMS) are a well-established component of prehospital trauma care in Germany. Reduced rescue times and increased catchment area represent presumable specific advantages of HEMS. In contrast, the availability of HEMS is connected to a high financial burden and depends on the weather, day time and controlled visual flight rules. To date, clear evidence regarding the beneficial effects of HEMS in terms of improved clinical outcome has remained elusive. Traumatized patients (Injury Severity Score; ISS ≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using the TraumaRegister DGU® of the German Society for Trauma Surgery. Only patients treated in German level I and II trauma centers with complete data referring to the transportation mode were included. Complications during hospital treatment included sepsis and organ failure according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus conference committee and the Sequential Organ Failure Assessment (SOFA) score. A total of 13,220 patients with traumatic injuries were included in the present study. Of these, 62.3% (n = 8,231) were transported by GEMS and 37.7% (n = 4,989) by HEMS. Patients treated by HEMS were more seriously injured compared to GEMS (ISS 26.0 vs. 23.7, P < 0.001) with more severe chest and abdominal injuries. The extent of medical treatment on-scene, which involved intubation, chest and treatment with vasopressors, was more extensive in HEMS (P < 0.001) resulting in prolonged on-scene time (39.5 vs. 28.9 minutes, P < 0.001). During their clinical course, HEMS patients more frequently developed multiple organ dysfunction syndrome (MODS) (HEMS: 33.4% vs. GEMS: 25.0%; P < 0.001) and sepsis (HEMS: 8.9% vs. GEMS: 6.6%, P < 0.001) resulting in an increased length of ICU treatment and in-hospital time (P < 0.001). Multivariate logistic regression analysis found that after adjustment by 11 other variables the odds ratio for mortality in HEMS was 0.75 (95% CI: 0.636 to 862). Afterwards, a subgroup analysis was performed on patients transported to level I trauma centers during daytime with the intent of investigating a possible correlation between the level of the treating trauma center and posttraumatic outcome. According to this analysis, the Standardized Mortality Ratio, SMR, was significantly decreased following the Trauma Score and the Injury Severity Score (TRISS) method (HEMS: 0.647 vs. GEMS: 0.815; P = 0.002) as well as the Revised Injury Severity Classification (RISC) score (HEMS: 0.772 vs. GEMS: 0.864; P = 0.045) in the HEMS group. Although HEMS patients were more seriously injured and had a significantly higher incidence of MODS and sepsis, these patients demonstrated a survival benefit compared to GEMS.
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DOI：
10.1097/00005373-199807000-00029
发表时间：
1998-07-01
影响因子：
--
作者：
Brathwaite, CEM;Rosko, M;Spott, MA
通讯作者：
Spott, MA
DOI：
10.1097/01.ta.0000244384.85267.c5
发表时间：
2008-03-01
影响因子：
--
作者：
Mulholland, Stephen A.;Cameron, Peter A.;Bernard, Stephen A.
通讯作者：
Bernard, Stephen A.
DOI：
10.1097/00005373-197403000-00001
发表时间：
1974-01-01
影响因子：
--
作者：
BAKER, SP;ONEILL, B;LONG, WB
通讯作者：
LONG, WB
影响因子：
2.4
作者：
Davis, Daniel P.;Fakhry, Samir M.;Robinson, Linda
通讯作者：
Robinson, Linda
影响因子：
1.6
作者：
Mommsen, Philipp;Bradt, Nikolas;Probst, Christian
通讯作者：
Probst, Christian