Severe Brain Injury Accidents Of Pre-Hospital,Hospital Emergency And Prognosis

Background and ObjectiveStatistics show that 130 million people worldwide each year are killed in road traffic injuries. With the rapid development of China's national economy, increasing year by year the number of vehicles, the occurrence of unexpected traffic injuries is rising, there are 8-9 million people die every year of traffic injury accidents, of which about 50%-70% of traffic due to brain to death. The results show that traffic accidents result in brain death, many factors influence the high rate of disability, the main thing is not timely pre-hospital ambulance or ambulance and first aid equipment, unskilled due to imperfect. In recent years, some developed countries, according to survey a large sample multi-center clinical studies, establishment and improvement of the acute brain injury prevention and control centers, science has developed emergency care, transport, the nearest hospital emergency treatment and other systems, and presented laws, regulations and public education, preventive measures. Thereby increasing the level of brain trauma treatment, making the incidence of acute brain injury decreased.Treatment of acute traumatic brain injury from the treatment methods of work to management compared with developed countries there is still a gap, mainly due to the lack of strict and complete standardization of treatment of traumatic brain injury program, the reason is the lack of a large epidemiological sample survey, a nationwide early treatment of acute traumatic brain injury situation has important reference value for statistical analysis.This article aims to more than forty hospitals nationwide through the traffic caused by hospitalized patients with acute severe traumatic brain injury were analyzed to explore the transport of acute traumatic brain injury occurred in the general law of development of China's relevant departments in acute traumatic brain injury prevention and control measures improve standardization of treatment procedures for brain injury to provide a scientific basis to improve the treatment system to improve the prevention and treatment of acute traumatic brain injury level.Methods1. since March 2008 by the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University organizations to develop "severe brain injury accidents of Tables ", the Southwest Hospital, Third Military Medical University, Tianjin Lake Hospital, First Affiliated Hospital of Fujian Medical University, First Clinical Hospital of Harbin Medical University, Guangdong Military District General Hospital, General Hospital of Lanzhou Military Region, the Committee of Experts and other 71 hospitals for examination and identification of specific statistical tables, statistical procedures, statistical methods.2. after the meeting, professional training, more hospitals are on April 1,2008 to begin clinical epidemiology. The data are standardized by the treating physician completed, signed by director of audit, and written information and electronic form is stored.3.1532 were collected results, after screening, in line with 1107 copies of statistical standards, the unit total of 40, they are:Southwest Hospital, Third Military Medical University, Tianjin Medical University General Hospital, Guangzhou Military General Hospital, Harbin Medical First Clinical Hospital of the University, Lanzhou Military General Hospital, Guangdong Medical College Hospital, West China Hospital of Sichuan University, Guangdong Sanjiu Brain Hospital, Haikou City People's Hospital, Guangdong Provincial People's Hospital of Qingxin County, Guangdong Province, Meizhou City People's Hospital, Foshan City, the first A People's Hospital, Guangdong Yangjiang City People's Hospital, the First People's Hospital of Shunde, Guangzhou Huadu District People's Hospital, Jiangmen City, Guangdong People's Hospital, Guangdong Provincial Land Reclamation Center, Tianjin Lake Hospital,175 Hospital of PLA, Dongguan City, Guangdong Province Huang River Hospital, Luoding City, Guangdong Province People's Hospital, Guangdong Province, the new County Hospital, Yingde City, Guangdong Province People's Hospital, First Affiliated Hospital of Fujian Medical University, Sichuan Liangshan Yi Autonomous Prefecture of First People's Hospital, the First People's Hospital of Zhaoqing City, Guangdong Province, Chongqing Fuling Central Hospital, Tianjin Jinghai County Hospital, Tianjin Armed Police Corps Hospital, Yunfu City, Guangdong People's Hospital, Chang Ping, Dongguan City, Guangdong Province People's Hospital, Sichuan Liangshan Yi Autonomous Prefecture Second People's Hospital, Hospital Shi Jie, Dongguan City, Guangdong Province, Second People's Hospital of Guangdong Province, Shenzhen Second People's Hospital, Dongguan City People's Hospital, Qingyuan City People's Hospital, the Armed Police Corps Hospital of Guangdong Province, Guangdong Provincial People's Hospital Wengyuan County, Guangzhou City,120 centers.4. General Information:(1) The patient's name, age, birthplace, date, hospital number, etc.(2) The location of traffic accidents, traffic police received a 120 call or the time, the ambulance out of the bus time and the time the ambulance arrived at the scene, on-site rescue time, injury time, transport vehicles, tools, cause of injury, the injured area, associated injuries, State of consciousness, vital signs, and other rescue situation.(3) transport the wounded and rescue emergency department:from the on-site emergency department arrival time, in the emergency department rescue, inspection time; when the patient reaches the emergency department:the state of consciousness, vital signs, pupillary changes, GCS score, emergency department treatment Results.(4) hospital emergency treatment:The patient arrives Neurosurgery time, vital signs, pupillary changes,1,3,5,7 days of admission blood gas analysis, blood biochemical tests, admission GCS score and 1,2,5,7,21 days State of consciousness, 1,3,7,21 days after admission CT,1,3,5,7 days after admission intracranial pressure detection, treatment, complications, hospital discharge or 1 month recovery:GOS score, Medical records of patients with CT, blood chemistry, blood gas analysis report copy.5. prognostic criteriaAccording to hospital uniform standardized treatment, and rehabilitation of the situation three months after discharge, GOS grade prognostic application to be reported to the scene from different time periods, and arrived at the scene to rescue the time, analysis and prognosis of patients exist Correlation.6. The data is aggregated and then serious, stringent screening, removal of the statistical failure patients, according to GCS score 8 points or less in the collection, and in accordance with the provisions of statistical tables; statistical analysis: According to the "traffic accident statistics of severe traumatic brain injury Table "of the statistical content, after application of statistical software SPSS13.0 spearman correlation, X2 test and other related data analysis. ResultsThis paper reported time to reach the scene of time respectively≤10 min, <10-20 min,<20-30 min,<30-40 min,<40 min or more time periods are divided into five groups of patients at different time condition, divided into death, plant survival, severe disability, moderate disability, five were statistically sound, of which 18.5% mortality of≤10 min, and<40 min above the 28.4% mortality; site rescue time was also more than the same Statistics, of which 23.4% mortality rate≤5min, and<30 min more than 46.4% mortality rate.According to statistics,1,107 cases were reported to be from time to time to analyze the scene and on-site rescue time is analyzed and the time correlation with the prognosis of six months, to do chi-square trend test, showed statistically significant (= 10.70, P=0.001), From the time officers arrived at the scene correlated with prognosis; by Spearman correlation analysis for the difference was statistically significant (rs=-0.095, P=0.002), shows that from the time officers arrived at the scene negatively correlated with prognosis, Sped to the scene from time increased, the worse the prognosis; test (X2=11.12, P=0.001), the on-site rescue time is correlated with prognosis; by Spearman correlation analysis for the difference was statistically significant (rs=-0.06, P=0.034), that on-site rescue time negatively correlated with prognosis, that with the on-site rescue time increases, the worse the prognosis.Time in the hospital emergency, according to data from the macro point of view out of the histogram, in most indicators, the histogram peak under good conditions reduced exacerbations increase in peak condition, so it can be qualitative That prolonged treatment in the emergency department, the overall condition worsened. According to functional data analysis:into the clinic after the due time, the patient's condition is serious. ConclusionReported to the scene from the time and on-site rescue time, correlated with the prognosis of patients by making spearman correlation studies can be seen from the time the ambulance to the scene reported the rescue of time, with time, the prognosis is poor, death Rate and disability gradually increased, proportional to the relationship; through the data graph and compare functions and values such as the various indicators of the overall comprehensive decision, hospital emergency along with the time, the patient's condition gradually worsened; the overall response to the emergency response can be The ability of speed, delay time of the road, field and hospital emergency treatment and prognosis associated with the time, try to shorten this time period, the prognosis is to reduce disability.China and some developed countries, save time early in the accident, rescue techniques, medical equipment, etc. There is a gap in China's economically developed regions and underdeveloped regions there is a big gap, which affected prognosis wounded, the Government needs Inputs and the efforts of the whole society, we should seize the medical rescue work time, establish and improve various simple and effective rescue procedures and shorten the hospital, the hospital ambulance time and improve the quality of on-site ambulance, but also the formal rescue training collaboration with medical institutions to improve the on-site rescue equipment, universal knowledge and advocacy for rescuing, etc., in order to reduce death and disability.