高能钝性骨盆环损伤与院前骨盆固定器的应用--基于前瞻性登记的回顾性评估。

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE Injury-International Journal of the Care of the Injured Pub Date : 2024-10-15 DOI:10.1016/j.injury.2024.111958
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引用次数: 0

摘要

简介:在院前环境中应用骨盆固定器是高能量钝性骨盆环损伤(PRI)处理方案的关键步骤。这项回顾性队列研究旨在评估在一家一级创伤中心治疗的高能量钝性骨盆环损伤 B 型或 C 型患者中应用院前骨盆固定器的比例,并评估其对医疗资源需求和患者预后的影响:筛选符合以下纳入标准的重伤患者:(1) 高能量钝性 PRI;(2) 2014.01.01 至 2022.12.31 期间入院;(3) 年龄≥16 岁;(4) 可进行骨盆计算机断层扫描。排除标准为(1) 入院前死亡;(2) 低能量损伤;(3) 穿透伤、爆炸伤和电击伤;(4) 二次转院。研究变量包括骨盆固定器的院前应用以及人口统计学、临床、管理和结果数据,均从登记表中提取。此外,还确定了 AO/OTA 分类:结果:共有 262 名患者被纳入最终分析。其中,58.8%的患者接受了院前骨盆固定器(PPB),从A型(45.1%)增加到B型(57.8%)和C型(73.7%)。院前血流动力学不稳定是引发高能量钝性 B 型 PRI 患者使用 PPB 的主要因素,其中 76.9% 的病例存在血流动力学不稳定,而 51.3% 的病例没有血流动力学不稳定(P = 0.009)。对于高能量钝性 C 型 PRI 患者,这一差异没有统计学意义(82.8% 对 64.3%,p = 0.200)。在 B 型 PRI 中,有一名医生在创伤现场是导致使用 PPB 的 PRI 百分比从 43.5% 增加到 67.3% 的原因之一(p = 0.011),而在 C 型 PRI 中,有一名医生在创伤现场是导致使用 PPB 的 PRI 百分比从 50% 增加到 77.1%(p = 0.257)的原因之一。该研究表明,在接受 PPB 治疗的亚组中,对包装红细胞 (PRBC) 输血的需求增加,而在重症监护室 (ICU) 和住院总时间以及并发症方面,接受或未接受 PPB 治疗的高能量钝性 B 型或 C 型 PRI 患者之间没有显著的统计学差异。对使用和未使用PPB的患者死亡率进行比较后发现,使用PPB的AIS肢体参与ISS总量至少50%的患者死亡率呈下降趋势:结论:在理想的院前情况下,每个高能量钝性 B 型或 C 型 PRI 患者都应接受 PPB 治疗。持续的院前团队培训和信息对实现这一目标至关重要。急诊科和重症监护室在收治 PPB 患者时,应准备好足够数量的 PRBC 以备输血。死亡率似乎并未受到 PPB 的影响,但 PRI 是总体伤势严重程度主要组成部分的患者死亡率有降低的趋势。这可能说明了 PPB 对高能量钝性 PRI 患者的重要积极作用。
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High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications – A retrospective assessment based on a prospective registry

Introduction

Application of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes.

Methods

The institutional Severely Injured Patients’ Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined.

Results

A consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257).
This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB.
Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS.

Conclusion

In the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
期刊最新文献
Editorial Board Fracture-related infection blood-based biomarkers: Diagnostic strategies The value of current diagnostic techniques in the diagnosis of fracture-related infections: Serum markers, histology, and cultures Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria In vivo models of infection: Large animals – Mini review on human-scale one-stage revision in a porcine osteomyelitis model
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