被转移到创伤中心的创伤性脑损伤患者的结果
Sai Krishna Bhogadi1, Collin Stewart1, Hamidreza Hosseinpour1
1Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
JAMA surgery
|August 28, 2024
概括
将近一半被转移到创伤中心的创伤性脑损伤 (TBI) 患者来自较低级别的设施. 超过三分之一的这些患者在48小时内没有进行任何干预就得到了出院,这凸显了改善TBI管理准则的必要性.
科学领域:
- 神经外科 神经外科
- 创伤外科 手术 创伤外科
- 公共卫生 公共卫生
背景情况:
- 在创伤性脑损伤 (TBI) 管理和全国患者转移协议中存在显著的变化.
- 优化对TBI患者的护理需要了解转移到专门创伤中心后的结果.
研究的目的:
- 评估转移到美国外科医生学院 (ACS) 一级或二级创伤中心 (TC) 的TBI患者的结果.
- 为了确定转移TBI患者的护理和资源利用的变化.
主要方法:
- 对ACS创伤质量改善计划数据库 (2017-2020年) 的二次分析.
- 包括成年患者与孤立的TBI和内出血转移到I/II水平的TC.
- 分析结果,包括头部CT扫描,神经外科干预,住院时间和死亡率,使用描述性统计和层次混合模型回归.
主要成果:
- 在117,651名TBI患者中,45.1%被转移. 37%的转移患者在没有神经外科干预的情况下在48小时内出院.
- 在创伤中心之间和内部观察到结果的广泛差异.
- 死亡率为6.5%;10%的患者到达格拉斯哥昏迷表得分为8或以下.
结论:
- 在I/II级创伤中心的TBI患者中,近一半来自其他设施的转移.
- 转移TBI患者中的很大一部分在出院前没有接受神经外科干预,这表明转移过程中的潜在效率低下.
- 需要全系统的指导方针来标准化TBI护理,改善资源配置,并优化患者分拣.
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