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Prehospital notification for major trauma patients requiring emergency hospital transport: A systematic review.
Journal of Evidence-Based Medicine ( IF 3.6 ) Pub Date : 2017-05-04 , DOI: 10.1111/jebm.12256
Anneliese Synnot 1, 2, 3, 4 , Adrian Karlsson 5 , Lisa Brichko 6 , Melissa Chee 3 , Mark Fitzgerald 3, 6 , Mahesh C Misra 7 , Teresa Howard 3 , Joseph Mathew 3, 6 , Thomas Rotter 8 , Michelle Fiander 9 , Russell L Gruen 10 , Amit Gupta 6, 7 , Satish Dharap 11 , Madonna Fahey 3 , Michael Stephenson 1, 12 , Gerard O'Reilly 3, 6, 13 , Peter Cameron 3, 6, 13 , Biswadev Mitra 3, 6, 13 ,
Affiliation  

OBJECTIVE This systematic review aimed to determine the effect of prehospital notification systems for major trauma patients on overall (<30 days) and early (<24 hours) mortality, hospital reception, and trauma team presence (or equivalent) on arrival, time to critical interventions, and length of hospital stay. METHODS Experimental and observational studies of prehospital notification compared with no notification or another type of notification in major trauma patients requiring emergency transport were included. Risk of bias was assessed using the Cochrane ACROBAT-NRSI tool. A narrative synthesis was conducted and evidence quality rated using the GRADE criteria. RESULTS Three observational studies of 72,423 major trauma patients were included. All were conducted in high-income countries in hospitals with established trauma services, with two studies undertaking retrospective analysis of registry data. Two studies reported overall mortality, one demonstrating a reduction in mortality; (adjusted odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39 to 0.94, 72,073 participants); and the other demonstrating a nonsignificant change (OR 0.61, 95% CI 0.23 to 1.64, 81 participants). The quality of this evidence was rated as very low. CONCLUSION Limited research on the topic constrains conclusive evidence on the effect of prehospital notification on patient-centered outcomes after severe trauma. Composite interventions that combine prehospital notification with effective actions on arrival to hospital such as trauma bay availability, trauma team presence, and early access to definitive management may provide more robust evidence towards benefits of early interventions during trauma reception and resuscitation.

中文翻译:

需要紧急医院转运的重大创伤患者的院前通知:系统评价。

目的本系统评价旨在确定主要创伤患者的院前通知系统对总体(<30天)和早期(<24小时)死亡率,医院接待以及到达时,达到关键时间所需的创伤团队(或同等水平)的影响干预措施和住院时间。方法包括在需要紧急转运的重大创伤患者中,院前通知与无通知或其他类型通知相比的实验和观察性研究。使用Cochrane ACROBAT-NRSI工具评估偏倚风险。进行叙述性合成,并使用GRADE标准对证据质量进行评级。结果包括对72,423名重大创伤患者的三项观察性研究。所有这些手术都是在高收入国家/地区建立了创伤服务的医院进行的,两项研究对注册表数据进行了回顾性分析。两项研究报告了总体死亡率,一项表明死亡率降低;另一项研究表明死亡率降低。(调整后的优势比(OR)0.61,95%置信区间(CI)0.39至0.94,72,073名参与者);另一组则显示无显着变化(OR为0.61,95%CI为0.23至1.64,有81位参与者)。该证据的质量被评为非常低。结论对该主题的有限研究限制了院前通知对严重创伤后以患者为中心的结果的影响的确凿证据。综合干预措施,将院前通知与到达医院时的有效措施相结合,例如创伤区的可用性,创伤团队的存在,
更新日期:2019-11-01
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