Clinical effect on major trauma patients during simultaneous or overlapping presentations at an urban level I trauma center in Korea.

Chang Won Park, Woo Young Nho, Tae Kwon Kim, Sung Hoon Cho, Jae Yun Ahn, Kang Suk Seo
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Abstract

Objective: Overcrowding in an emergency department (ED) or intensive care unit (ICU) of the trauma center (TC) is an important issue for timely acute health care of a critically injured patient. Accumulated scientific evidence has indicated the negative influence of overcrowding to the process and clinical outcome of trauma care.

Method: The institutional trauma registry at an urban level I TC was retrospectively evaluated for 5 years (2018-2022). Major trauma was defined as an injury severity score (ISS) of >15. We determined simultaneous or overlapping presentations of major trauma (SOMT) in two or more patients with ISS of >15 who presented within a 4-h time window. When only two patients were included within a single time window, they were classified as SOMT-2, whereas when three or more patient clusters were identified in a single time window, they were classified as SOMT-3. The outcome measurement included process and clinical variables, such as trauma team activation (TTA) ratio, ED length of stay (LOS), time to blood product transfusion (TF), time to emergency surgery or intervention (ESI), ICU LOS, and mortality.

Result: A total of 2,815 patients were included, of which 39.6% (N = 1,116) classified as SOMT. The SOMT group had lower TTA ratio than the non-SOMT group (69.4% vs. 73.4%, P = 0.022). The TTA ratio exhibited a decreasing trend in non-SOMT, SOMT-2, and SOMT-3 groups (P = 0.006). The time to TF was significantly delayed in the SOMT group (129 vs. 91 min, P < 0.001).

Conclusion: SOMT regularly occurs and results in fewer trauma team activation and a delayed time to blood transfusion. The current intensive trauma care system should be strategically modified to improve critical trauma care and enhance disaster preparedness.

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韩国城市一级创伤中心对同时或重叠出现的重大创伤患者的临床影响。
目的:创伤中心(TC)急诊科(ED)或重症监护室(ICU)人满为患是危重伤员能否得到及时救治的一个重要问题。累积的科学证据表明,过度拥挤对创伤救治的过程和临床结果有负面影响:对某城市一级创伤中心的机构创伤登记进行了5年(2018-2022年)的回顾性评估。重大创伤定义为损伤严重程度评分(ISS)>15。我们确定了在 4 小时时间窗内同时或重叠出现重大创伤(SOMT)的两名或两名以上 ISS >15 的患者。如果在一个时间窗内只有两名患者,则将其归类为 SOMT-2;如果在一个时间窗内发现三名或三名以上患者,则将其归类为 SOMT-3。结果测量包括过程和临床变量,如创伤团队激活率(TTA)、急诊室住院时间(LOS)、输血时间(TF)、急诊手术或干预时间(ESI)、重症监护室住院时间和死亡率:共纳入 2,815 名患者,其中 39.6%(N=1,116)被归类为 SOMT。SOMT 组的 TTA 比率低于非 SOMT 组(69.4% 对 73.4%,P = 0.022)。非 SOMT 组、SOMT-2 组和 SOMT-3 组的 TTA 比率呈下降趋势(P = 0.006)。结论:SOMT 组的 TF 时间明显延迟(129 分钟对 91 分钟,P < 0.001):结论:SOMT经常发生,导致创伤团队启动次数减少,输血时间延迟。目前的重症创伤护理系统应进行战略性调整,以改善重症创伤护理并加强灾难准备。
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