微信平台对急诊创伤患者急诊滞留时间及预后的影响
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摘要
目的探讨微信平台对急诊创伤患者急诊滞留时间(EDLOS)及预后的影响。方法建立以上海市第六人民医院急救创伤中心为核心,急诊预检、"120"院前急救系统、急诊科以及奉贤区中心医院参与的微信平台。纳入203例创伤患者,根据微信平台的应用时间,将患者分为应用前组82例和应用后组121例。比较两组伤情特点、诊治情况及预后。采用Logistic回归模型分析临床预后(脓毒血症、呼吸机通气时间、ICU住院时间)的独立危险因素。结果两组格拉斯哥昏迷量表评分、就诊时间、ICU住院时间、呼吸机通气时间、手术情况、28 d内死亡情况、脓毒症发生情况比较,差异有统计学意义(均P <0. 05)。经过倾向评分匹配后,应用后组脓毒症发生率、EDLOS低于或短于应用前组(P <0. 05)。Logistic回归分析结果显示,EDLOS长、女性、呼吸机通气时间长、ICU住院时间长、创伤严重程度评分高及未使用微信平台是发生脓毒血症的危险因素(均P <0. 05)。脓毒症及ICU住院时间长是呼吸机通气时间长的危险因素(均P <0. 05)。呼吸机通气时间长是ICU住院时间长的危险因素(P <0. 05)。结论微信平台的应用可缩短创伤患者的EDLOS;未使用微信平台可增加患者脓毒血症发生风险,这可能与延长EDLOS有关。
Objective To evaluate the impact of WeChat platform on emergency department length of stay( EDLOS) and prognosis in emergency trauma patients. Methods With Emergency Trauma Center of Shanghai Sixth People's Hospital at its core,a We Chat platform was developed involving emergency pre-check,120 pre-hospital first aid system,emergency department,and Fengxian District Central Hospital. Totally 203 trauma patients enrolled were divided into pre-implementation group( n = 82) and post-implementation group( n = 121) according to the performance duration of the WeChat platform. Features of the conditions,diagnosis and treatment,as well as prognosis,were compared between the two groups. Logistic regression model was used to analyze independent risk factors for clinical prognosis,such as sepsis,duration of mechanical ventilation,and ICU stay. Results There were statistically significant differences were found between the two groups in Glasgow Coma Scale( GCS) score,consulting hours,ICU stay,duration of mechanical ventilation,operation condition,mortality within 28 days,and incidence of sepsis( all P < 0. 05). After propensity score matching,the post-implementation group experienced a lower incidence rate of sepsis,and shorter EDLOS than the pre-implementation group( P < 0. 05). The results of Logistic regression analysis showed that prolonged EDLOS,female,long duration of mechanical ventilation,prolonged ICU stay,high injury severity score,and no use of the WeChat platform were risk factors for sepsis( all P < 0. 05). Sepsis and prolonged ICU stay were risk factors for long duration of mechanical ventilation( all P < 0. 05). Long duration of mechanical ventilation was a risk factor for prolonged ICU stay( P < 0. 05). Conclusion The application of the We Chat platform can shorten EDLOS in trauma patients; the absence of the We Chat platform might increase the risk of sepsis occurrence,which may be associated with prolonged EDLOS.
Objective To evaluate the impact of WeChat platform on emergency department length of stay( EDLOS) and prognosis in emergency trauma patients. Methods With Emergency Trauma Center of Shanghai Sixth People's Hospital at its core,a We Chat platform was developed involving emergency pre-check,120 pre-hospital first aid system,emergency department,and Fengxian District Central Hospital. Totally 203 trauma patients enrolled were divided into pre-implementation group( n = 82) and post-implementation group( n = 121) according to the performance duration of the WeChat platform. Features of the conditions,diagnosis and treatment,as well as prognosis,were compared between the two groups. Logistic regression model was used to analyze independent risk factors for clinical prognosis,such as sepsis,duration of mechanical ventilation,and ICU stay. Results There were statistically significant differences were found between the two groups in Glasgow Coma Scale( GCS) score,consulting hours,ICU stay,duration of mechanical ventilation,operation condition,mortality within 28 days,and incidence of sepsis( all P < 0. 05). After propensity score matching,the post-implementation group experienced a lower incidence rate of sepsis,and shorter EDLOS than the pre-implementation group( P < 0. 05). The results of Logistic regression analysis showed that prolonged EDLOS,female,long duration of mechanical ventilation,prolonged ICU stay,high injury severity score,and no use of the WeChat platform were risk factors for sepsis( all P < 0. 05). Sepsis and prolonged ICU stay were risk factors for long duration of mechanical ventilation( all P < 0. 05). Long duration of mechanical ventilation was a risk factor for prolonged ICU stay( P < 0. 05). Conclusion The application of the We Chat platform can shorten EDLOS in trauma patients; the absence of the We Chat platform might increase the risk of sepsis occurrence,which may be associated with prolonged EDLOS.
引文
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[2] Singer AJ,Thode HC Jr,Viccellio P,et al. The association between length of emergency department boarding and mortality[J]. Acad Emerg Med,2011,18(12):1 324-1 329.
[3] London JA,Battistella FD. Is there a relationship between trauma center volume and mortality?[J]. J Trauma,2003,54(1):16-24
[4]贺行巍,赵虎,丁晨,等.微信平台在优化急诊直接经皮冠状动脉介入治疗救治流程中的应用[J].中国介入心脏病学杂志,2017,25(1):27-30.
[5]周志道.创伤评分的现状和展望[J].中华创伤杂志,1994,10(1):33-34.
[6]程宝珍,林文风,冯志华,等.格拉斯哥昏迷评分在中重型颅脑损伤患者急救中的应用[J].中国急救复苏与灾害医学杂志,2015,10(10):967-968.
[7]陈德昌.多发伤救治面临的挑战[J].中华创伤杂志,2004,20(1):7-9.
[8]陈明玉,刘林成,唐剑星.院前急救医学[M].武汉:湖北科学技术出版社,1999:375.
[9] Li W,Han LQ,Guo YJ,et al. Using We Chat official accounts to improve malaria health literacy among Chinese expatriates in Niger:an intervention study[J]. Malar J,2016,15(1):567.
[10] Zeng F,Deng G,Wang Z,et al. We Chat:a new clinical teaching tool for problem-based learning[J]. Int J Med Educ,2016,7:119-121.
[11] Xu X,Lin Q,Zhang Y,et al. Influence of We Chat on sleep quality among undergraduates in Chongqing,China:a crosssectional study[J]. Springerplus,2016,5(1):2 066.
[12]叶立刚,许永安,何小军,等.收住ICU多发伤患者急诊科滞留时间与预后的关系[J].中华创伤杂志,2014,30(8):798-802.
[13] Mowery NT,Dougherty SD,Hildreth AN,et al. Emergency department length of stay is an independent predictor of hospital mortality in trauma activation patients[J]. J Trauma,2011,70(6):1 317-1 325.
[14]邓毅,陈晓梅.多发伤患者入住ICU时间延长的危险因素[J].创伤外科杂志,2017,19(7):530-532.