Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n=187), the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values was performed in greater numbers when compared with cases led by surgeons (n=501). There was a statistically significant relationship (p<0.01) between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28) in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

摘要
目的：评估急诊室当班急诊医师与/或外科医师对交通事故受害者的救治工作开展情况。
方法：本研究于2013年7月至2014年7月期间，在巴西巴拉那州马林加市城区的转诊医院内开展，针对交通事故受害者的救治工作进行一项回顾性描述性探索研究。研究通过向接诊医师发放问卷的方式，收集其人口学特征与职业培训相关信息。
结果：本研究共评估688份病例记录，其中99%的患者院前修正创伤评分（Revised Trauma Score）为12分。统计学分析显示，相较于外科医师主导的病例（n=501），急诊医师主导的病例（n=187）中，格拉斯哥昏迷量表（Glasgow Coma Scale）记录率与外科手术操作实施率均更低，而血压值记录率则更高。住院时长与救治医师的专科类型存在统计学意义上的显著关联（p<0.01）：急诊医师救治组患者的住院时长处于1~6小时区间的概率更高（粗比值比crude OR=28）。本研究纳入的多数医师较为年轻，急诊从业年限为1~2年，且均接受过高级创伤生命支持（Advanced Trauma Life Support, ATLS）培训；其中60%的参训医师是在近4年内完成该培训课程的。外科医师完成了73%的院内救治工作。
结论：针对轻度损伤的交通事故受害者，急诊医师与外科医师在格拉斯哥昏迷量表评估、血压值记录、急诊室救治方案选择以及住院时长管控方面，均存在差异化的诊疗思路。