就诊时间与急诊创伤患者滞留及预后的关系

The effect of arrival time on emergency retention and prognosis in patients with severe trauma

目的研究就诊时间与急诊创伤患者急诊室滞留及预后的关系。方法从苏州大学附属第一医院创伤中心信息系统提取2016年11月1日至2019年11月30日在急诊抢救室诊治的1738例急诊创伤患者的临床数据,将从挂号到急诊出科≥4 h定义为急诊室滞留,以8:00,15:00及22:00为界将一天分为早、中、夜三个班次,以早班为参考基线,以急诊室滞留为因变量通过logistic回归模型计算就诊班次的比值比(OR)以及经过年龄、性别及修正创伤评分(revised trauma score,RTS)校正的OR,并以急诊死亡为终点做COX回归分析。结果纳入的1738例急诊创伤患者中,发生急诊室滞留共852人次(49.02%),以早班为参考基线,中班及夜班的急诊室滞留风险逐渐增加,单因素和多因素logistic回归分析夜班的滞留风险OR=2.21,95%CI:1.71~2.86;OR=2.37,95%CI:1.76~3.18,均P<0.01。在单因素COX回归中,夜班HR=0.26,95%CI:0.08~0.90,P=0.033,有统计学意义,但在多因素COX回归中,中班HR=0.96,95%CI:0.43~2.14,P=0.914;夜班HR=0.40,95%CI:0.08~1.85,P=0.238,均差异无统计学意义。结论急诊创伤患者不同时间段就诊对其发生急诊室滞留有一定影响,夜班时间就诊的患者更容易发生滞留,但不同就诊时间的急诊死亡风险差异不明显。

Objective To explore the relationship between arrival time and the retention in emergency room and the prognosis in patients with severe trauma.Methods The clinical data of 1738 emergency trauma patients in emergency intensive care from trauma center information system of the First Affiliated Hospital of Soochow University were extracted.The emergency retention was the time in the emergency room≥4 h.The 24 h of the day was divided into three shifts at 8:00,15:00 and 22:00.Logistic regression model was used to calculate the crude OR and adjusted OR after adjustment by age,sex and RTS of emergency shifts,and COX regression analysis was performed with emergency death as the endpoint.Results Among the total of 1738 patients with severe trauma,there were 852(49.02%)cases of emergency retention.Taking the morning shift as the reference baseline,the risks of emergency retention in middle shift and night shift were increased gradually.The OR value of night shift was statistically significant(P<0.01),and the crude OR and adjusted OR were 2.21(95%CI:1.71-2.86)and 2.36(95%CI:1.76-3.18),respectively.The univariate COX regression model indicated that the crude HR of night shift was statistically significant(HR=0.26,95%CI:0.08-0.90,P=0.033).However,the multivariate COX regression model showed no statistically significant differences in the adjusted HR of middle shift(HR=0.96,95%CI:0.43-2.14,P=0.914)and night shift(HR=0.40,95%CI:0.08-1.85,P=0.238),respectively.Conclusions The arrival time of emergency trauma patients might be a contributor to the emergency retention,and night shift patients are more likely to encounter retention,but there is no significant effect on patient death.