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[JAMA Surgery发表论文]:美国急救响应时间与车祸死亡率的相关性
2019年05月19日 时讯速递, 进展交流 暂无评论

Original Investigation February 6, 2019

Association Between Emergency Medical Service Response Time and Motor Vehicle Crash Mortality in the United States

James P. Byrne, N. Clay Mann, Mengtao Dai, et al

JAMA Surg. 2019;154(4):286-293. doi:10.1001/jamasurg.2018.5097

Abstract

Importance 背景

Motor vehicle crashes (MVCs) are a leading public health concern. Emergency medical service (EMS) response time is a modifiable, system-level factor with the potential to influence trauma patient survival. The relationship between EMS response time and MVC mortality is unknown.

车祸(MVCs)是非常重要的公共卫生问题。急救医疗服务(EMS)响应时间是可以改变的系统性因素,可能影响创伤患者生存率。EMS响应时间与MVC病死率的关系尚不清楚。

Objectives 目的

To measure the association between EMS response times and MVC mortality at the population level across US counties.

在美国县级人口水平研究EMS响应时间与MVC病死率的相关性

Design, Setting, and Study Population 试验设计、场景和研究人群

This population-based study included MVC-related deaths in 2268 US counties, representing an estimated population of 239 464 121 people, from January 1, 2013, through December 31, 2015. Data were analyzed from October 1, 2017, through April 30, 2018.

这项基于人口的研究纳入了2013年1月1日至2015年12月31日期间,美国2268个县(估计人口239,464,121)MVC相关死亡。2017年10月1日至2018年4月30日进行数据分析。

Exposure 暴露因素

 The median EMS response time to MVCs within each county (county response time), derived from data collected by the National Emergency Medical Service Information System.

根据全国急救医疗信息系统收集的数据,得到每个县EMS对于MVCs的响应时间中位数(县响应时间)

Main Outcomes and Measures 主要预后指标

The county rate of MVC-related death, calculated using crash fatality data recorded in the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration.

根据全国高速公路交通安全管理局死亡率分析报告系统记录的车祸死亡数据,计算每个县MVC相关死亡率

Results 结果

During the study period, 2 214 480 ambulance responses to MVCs were identified (median, 229 responses per county [interquartile range (IQR), 73-697 responses per county]) in 2268 US counties. The median county response time was 9 minutes (IQR, 7-11) minutes. Longer response times were significantly associated with higher rates of MVC mortality (≥12 vs <7 minutes; mortality rate ratio, 1.46; 95% CI, 1.32-1.61) after adjusting for measures of rurality, on-scene and transport times, access to trauma resources, and traffic safety laws. This finding was consistent in both rural/wilderness and urban/suburban settings, where a significant proportion of MVC fatalities (population attributable fraction: rural/wilderness, 9.9%; urban/suburban, 14.1%) were associated with prolonged response times (defined by the median value, ≥10 minutes and ≥7 minutes, respectively).

在研究期间,美国2268个县共有2214480起MVCs的EMS响应(每个县中位数,229起响应[四分位区间(IQR), 73-697]。在针对城乡、现场及转运时间、创伤资源可及性及交通安全法规进行校正后,较长的响应时间与MVC高病死率显著相关(≥12 vs <7分钟,病死率比值,1.46; 95% CI, 1.32-1.61)。在乡村/野外和城市/郊区也得到一致结果,即相当部分的MVC死亡(人口贡献比例:乡村/野外,9.9%;城市/郊区,14.1%)与较长的响应时间(根据中位时间定义,分别为≥10 分钟和 ≥7 分钟)有关。

Conclusions and Relevance 结论与意义

Among 2268 US counties, longer EMS response times were associated with higher rates of MVC mortality. A significant proportion of MVC-related deaths were associated with prolonged response times in both rural/wilderness and urban/suburban settings. These findings suggest that trauma system–level efforts to address regional disparities in MVC mortality should evaluate EMS response times as a potential contributor.

在美国2268个县中,较长的EMS响应时间伴随较高的MVC病死率。乡村/野外和城市/郊区环境下,相当部分的MVC相关死亡与响应时间过长有关。这些发现提示,创伤系统层面在努力消除MVC病死率的地区差异时,应当把EMS响应时间作为可能的影响因素进行评估。

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