Study Of Prognosis For Trauma Patients By Different Transport Patterns

Objective:The purpose of the study is to compare the outcomes of the trauma patients who were transported directly to Level III hospital with those who were transferred after being first transported to less specialized hospitals.In order to develop a new integrated model of socialized multi-level emergency medical service system.Methods:264 moderate and severe trauma patients admitted to the emergency department of Xiangya Hospital were collected from August 2008 to December 2009. The outcomes included the severe complications, mortality of the first 30 days after injury, and the length of stay in intensive care unit. We used SPSS 16.0 statistical software for statistical analysis.Results:The mean age of the patients was approximately 42.6±0.877 years old, and 82.6% were males.The predominant mechanism of injury was motor vehicle crashes.The direct and indirect transport groups were similar with respect to age, gender, mechanism of injury, RTI scores and GCS scores.Outcomes of the two groups are described as follow:1.Between the direct transport group and indirect transport group, the incidence of complications were 13.2%(15/114) and 26% (39/150), the difference was statistically significant (P=0.010).2.When compared with the direct transport group, indirect transported patients were at increased risk for overall mortality in 30 days after injury (direct,7%;indirect,19.3%),the difference was statistically significant (P=0.004).3.The length of stay in intensive care unit when comparing the direct group with the indirect group had no statistical difference(direct,57.76±47.77h;indirect,62.19±45.53h;P=0.445).4.In the moderate trauma patients, the incidence of complications between direct transport group and indirect transport group were 6.8%(3/44) and 7.3%(3/41),there was no statistical difference(P=0.929); the mortality of direct group and indirect group were 0%(0/44) and 4.9(2/41),there was no significant statistical difference(P=0.138). Meanwhile, the length of stay in intensive care unit of each group were 34.43±24.04h and 35.46±28.78h, the difference was not statistically significant(P=0.936).5.In the severe trauma patients, the incidence of complications between direct and indirect group were 7.1%(12/70) and 33%(36/109), the difference was statistically significant(P=0.019); the mortality of direct and indirect group were 11.4%(8/70) and 24.8%(27/109), the difference was statistically significant(P=0.028).However, the length of stay in intensive care unit of each group were 71.71±52.86h and 73.75±47.28h, the difference was not statistically significant (P=0.364).Conclusions:The results of this study had shown that transportation of severely injured patients from the scene directly to Level III hospital was associated with a reduction in mortality and incidence of complications in 30 days after injury compared with that transportation to lower level hospital.