Variation in the Type, Rate, and Selection of Patients for Out-of-hospital Airway Procedures Among Injured Children and Adults
Variation in the Type, Rate, and Selection of Patients for Out-of-hospital Airway Procedures Among Injured Children and Adults
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DOI：
10.1111/j.1553-2712.2009.00604.x
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发表时间：
2009-12-01
影响因子：
4.4
通讯作者：
Daya, Mohamud R.
中科院分区：
文献类型：
--
作者：
Newgard, Craig D.;Koprowicz, Kent;Daya, Mohamud R.
目的：目的是比较的类型，率，并选择受伤的患者在医院外的气道程序之间的紧急医疗服务（EMS）机构在10个站点横跨北美。方法：作者分析了一个连续的病人，前瞻性队列登记受伤的成人和儿童与医院外的先进的气道尝试，收集从2005年12月1日，通过2007年2月28日，由181 EMS机构在10个站点横跨美国和加拿大。高级气道手术定义为经口气管插管、经鼻气管插管、声门上气道或环甲膜切开术。根据10个部位的年龄特异性人群值和现场生理异常（收缩压< 90 mm Hg，呼吸频率< 10 or >29次/min，格拉斯哥昏迷量表[GCS]评分< 12）的受伤患者数量计算气道手术率。描述性措施被用来比较患者之间的sites.Results：共有1,738例患者至少有一个先进的气道尝试，并纳入分析。不同研究中心进行的气道手术类型差异很大，包括经口气管插管（63%-99%）、声门上气道（0 - 27%）、经鼻气管插管（0 - 21%）和环甲膜切开术（0 - 2%）。快速序列插管（RSI）的使用率从0%到65%不等。现场气道干预的人群调整率（按研究中心）范围为每10万成人1.2至22.8例，每10万儿童0.2至4.0例。在有生理异常的创伤患者中，一些机构在几乎50%的患者中进行了气道手术，而其他机构在不到10%的患者中使用了这些手术。也有很大的变化，在人口特征，生理措施，损伤机制，运输方式，现场心肺复苏，和未调整的死亡率之间的气道patients.Conclusions：在北美的10个网站，有很大的变化类型的医院外的气道程序进行，基于人口的气道干预率，并选择受伤的病人这样的程序。
Objectives:The objective was to compare the type, rate, and selection of injured patients for out-of-hospital airway procedures among emergency medical services (EMS) agencies in 10 sites across North America.Methods:The authors analyzed a consecutive patient, prospective cohort registry of injured adults and children with an out-of-hospital advanced airway attempt, collected from December 1, 2005, through February 28, 2007, by 181 EMS agencies in 10 sites across the United States and Canada. Advanced airway procedures were defined as orotracheal intubation, nasotracheal intubation, supraglottic airway, or cricothyrotomy. Airway procedure rates were calculated based on age-specific population values for the 10 sites and the number of injured patients with field physiologic abnormality (systolic blood pressure of < 90 mm Hg, respiratory rate of < 10 or > 29 breaths/min, Glasgow Coma Scale [GCS] score of < 12). Descriptive measures were used to compare patients between sites.Results:A total 1,738 patients had at least one advanced airway attempt and were included in the analysis. There was wide variation between sites in the types of airway procedures performed, including orotracheal intubation (63% to 99%), supraglottic airways (0 to 27%), nasotracheal intubation (0 to 21%), and cricothyrotomy (0 to 2%). Use of rapid sequence intubation (RSI) varied from 0% to 65%. The population-adjusted rates of field airway intervention (by site) ranged from 1.2 to 22.8 per 100,000 adults and 0.2 to 4.0 per 100,000 children. Among trauma patients with physiologic abnormality, some sites performed airway procedures in almost 50% of patients, while other sites used these procedures in fewer than 10%. There was also large variation in demographic characteristics, physiologic measures, mechanism of injury, mode of transport, field cardiopulmonary resuscitation, and unadjusted mortality among airway patients.Conclusions:Among 10 sites across North America, there was wide variation in the types of out-of-hospital airway procedures performed, population-based rates of airway intervention, and the selection of injured patients for such procedures.