“互联网+创伤急救”区域性可视化院前急救模式的研究

Research on the regional visualized pre-hospital emergency medical mode of"Internet+Trauma First Aid"

目的 探讨创伤超声重点评估(focused assessment with sonography for trauma, FAST)在区域性院前创伤患者中应用,利用“互联网+创伤急救”建立一个集统筹调度、绿色通道等功能的院前可视化急救模式。方法 自2020年6月起,广州市番禺区在全区范围内采用FAST对院前创伤患者进行创伤评估,开展区域性院前可视化急救,2021年12月完成培训工作。收集2020年6月至2023年6月期间全区创伤急救患者的数据,将2020年6月至2021年12月的患者分为对照组,2022年1月至2023年6月的患者分为实验组。利用“急救绿道”APP、紫云系统以及各医院信息系统收集急诊准备时间、FAST完成时间、术前准备时间、门术时间,以及漏诊、误诊、死亡人数等信息,采用大数据回顾性分析院前可视化急救实施效果。结果 回顾性分析符合标准的804例急诊创伤患者显示,与对照组相比,实验组明显缩短急诊准备时间[(2.23±1.30)min vs.(11.54±4.61)min]、FAST完成时间[(9.08±3.45)min vs.(29.23±5.36)min]、超声检查准备时间[(2.43±0.79)min vs.(11.14±3.29)min]、紧急手术术前准备时间[(21.45±6.73)min vs.(46.15±17.10)min]、门术时间[(40.44±25.20)min vs.(71.40±47.65)min],差异有统计学意义(P<0.05);实验组在信息预警比例(82.9%vs. 63.8%)、直达手术室比率(4.98%vs. 0.01%)高于对照组,差异有统计学意义(P<0.05);实验组在漏诊率(3.9%vs. 13.2%)、误诊率(1.3%vs. 4.9%)、病死率(0.2%vs. 2.6%)、严重创伤患者病死率(0.7%vs. 5.9%)明显低于对照组,差异有统计学意义(P<0.05)。结论 “互联网+创伤急救”区域性院前可视化急救模式缩短FAST完成时间、急诊准备时间和创伤救治时间,降低漏诊率和严重创伤患者病死率,实现创伤性疾病的快速、可视化、高效的诊疗,这种模式显著提高区域性创伤急救水平。

ObjectiveTo investigate the application of Focused Assessment with Sonography for Trauma(FAST)in pre-hospital trauma patients in a regional setting;and to establish a pre-hospital visualized emergency rescue model with functions such as coordinated scheduling and a green channel through"Internet+Trauma Emergency."Methods Starting from June 2020,the Panyu District of Guangzhou City implemented FAST for trauma assessment in pre-hospital trauma patients throughout the entire district,initiating regional pre-hospital visualized emergency rescue.The training was completed in December 2021.Data from trauma emergency patients in the entire district from June 2020 to June 2023 were collected.Patients from June 2020 to December 2021 were categorized as the control group,while patients from January 2022 to June 2023 were categorized as the experimental group.The"Emergency Green Path"app,Ziyun system,and various hospital information systems were used to collect information such as emergency preparation time,FAST completion time,preoperative preparation time,operative time,as well as data on misdiagnosis,missed diagnosis,and mortality.A retrospective analysis using big data was conducted to evaluate the implementation effects of pre-hospital visualized emergency rescue.Results A retrospective analysis of 804 emergency trauma patients who met the criteria showed that,compared to the control group,the experimental group significantly reduced emergency preparation time[(2.23±1.30)min],FAST completion time[(9.08±3.45)min],ultrasound examination preparation time[(2.43±0.79)min],preoperative preparation time for emergency surgery[(21.45±6.73)min],and operative time[(40.44±25.20)min],with statistical significance.The experimental group had a higher information alert ratio(82.9%)and direct-to-operating-room ratio(4.98%)compared to the control group,with statistical significance.The experimental group also exhibited significantly lower rates of missed diagnosis(3.9%),misdiagnosis(1.3%),mortality(0.2%),and mortality in severely injured patients(0.7%)compared to the control group,with statistical significance.Conclusion The regional pre-hospital visualized emergency rescue model of"Internet+Trauma Emergency"significantly shortened FAST completion time,emergency preparation time,and trauma treatment time,reduced the rates of missed diagnosis and mortality in severely injured patients,and achieved rapid,visualized,and efficient diagnosis and treatment of traumatic diseases.This model significantly elevated the level of regional trauma emergency rescue.