滴滴:医院前输管与更长的现场时间有关,没有任何生存益处
Madeline B Thomas1, Shane Urban1, Heather Carmichael2
1Department of Surgery, University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO.
在创伤患者的医院前内内管试验与更长的现场时间和没有生存益处有关. 建议优先考虑快速输送而不是实地输管,以获得更好的结果.
科学领域:
- 紧急医疗 紧急医疗
- 创伤护理 创伤护理
- 航空航道管理的管理.
背景情况:
- 在创伤中进行医院前内内输管 (PEI) 是有争议的,其益处的证据有限,并且人们越来越担心增加的发病率和死亡率.
- 现有研究表明PEI可能与不良结果有关,这促使进一步调查其与早期急诊室 (ED) 输管相比的疗效.
研究的目的:
- 为了比较创伤患者的结果,他们经历了医院前内管试验,与那些在到达急诊室时立即被输入管的人相比.
主要方法:
- 一个单一中心创伤登记的回顾性审查.
- 纳入标准:年龄≥15岁,地面救护车运输,在抵达10分钟内尝试PEI或ED输管,没有先前PEI.
- 倾向性得分匹配 (PSM) 和标准平均差异 (SMD) 用于平衡基线特征并评估群体之间的共变量平衡.
主要成果:
- 在208名患者中,95人 (46%) 尝试了PEI (47%的成功率),而113人 (54%) 在10分钟内被输入ED.
- 在PSM后,PEI与更长的现场时间 (9分钟与6分钟相比,P < .01) 相关,但整体死亡率没有差异 (67%与65%,P = 1.00).
- 在患有医院前停诊的患者中 (n=98),PEI与较短的死亡时间 (8分 vs. 14分,P = .008) 和较长的总运输时间 (23分 vs. 19分,P = .006) 相关,死亡率没有差异 (94% vs. 97%,P = 1.00).
结论:
- 在创伤中进行医院前内内管注射与较长的现场时间有关,并且没有提供生存优势.
- PEI的成功率不一致,可能会推迟最终的护理.
- 预科医院提供者应该优先考虑快速运输,而不是试图实地输管.
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