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地方における小児重症外傷患者の診療体制と集約化の課題(The medical care system for pediatric patients with severe trauma in local communities and problems related to their consolidation)
要旨 地方における小児重症外傷患者の診療体制を明らかにし，集約化の課題を抽出するため，2016年から2020年までに小児集中治療室（pediatric intensive care unit: PICU）に入室した15歳以下の小児外傷患者を対象とした。診療録を用いて後方視的に検討を行い，対象は113例，injury severity score >15の症例は55例（48.6%），probability of survival ≦ 50%の症例は2例（1.8%）であった。外傷部位は，頭頸部が最多の57例（50.4%），多発外傷は13例（11.5%）であった。搬送手段は，救急車・ドクター...
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| Published in: | Nihon Kyūkyū Igakkai zasshi 2021-11, Vol.32 (11), p.595-602 |
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| Main Authors: | , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites |
| Online Access: | Get full text |
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| Summary: | 要旨
地方における小児重症外傷患者の診療体制を明らかにし，集約化の課題を抽出するため，2016年から2020年までに小児集中治療室（pediatric intensive care unit: PICU）に入室した15歳以下の小児外傷患者を対象とした。診療録を用いて後方視的に検討を行い，対象は113例，injury severity score >15の症例は55例（48.6%），probability of survival ≦ 50%の症例は2例（1.8%）であった。外傷部位は，頭頸部が最多の57例（50.4%），多発外傷は13例（11.5%）であった。搬送手段は，救急車・ドクターカーによる陸路搬送とドクターヘリ・防災ヘリによる空路搬送の2群間において搬送距離の分布に有意差のあるばらつきがあった。搬送距離が40kmを超える症例が空路搬送では11例（55.0%），陸路搬送でも14例（19.5%）あった。陸路搬送の14例のうち12例は空路搬送の運行時間外であった。地方で小児重症外傷患者を集約化しても症例数は少なく，同時に空路搬送が不可能な状況では陸路での長距離搬送をせざるを得ない症例があった。集約化の方法に関して，搬送方法を含めた診療体制の整備が必要であることが示唆された。
ABSTRACT
To elucidate the medical care system for pediatric patients with severe trauma in local communities and identify problems associated with the consolidation of their care. The study included patients with severe trauma aged ≤15 years who were in the pediatric intensive care unit from 2016 to 2020. The status of patients’ care was retrospectively examined using medical records. Among 113 patients, 55 (48.6%) had an injury severity score of >15 and two (1.8%) had a survival probability of ≤50%. We investigated the mode of transportation by categorizing the various modes into two groups: overland and air transportation. The results showed a significant degree of variation with respect to transport distance. Patients transported more than 40 km included 11 (55.0%) who were transported by air and 14 (19.5%) who were transported overland. Among 14 patients who were transported ground, 12 were transported when air transportation was unavailable. Even when patients with severe trauma in local communities are consolidated, the number of patients is small. Furthermore, some patients were transported ground for long distances owing to the unavailability of air transportation. This finding suggests that it would be necessary to revise the medical care system, including modes of transportation, to consolidate patients. |
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| ISSN: | 1883-3772 1883-3772 |
| DOI: | 10.1002/jja2.12642 |