基层医院急性创伤性脊髓损伤的流行病学特点及 “组团式”紧密型帮扶对其诊疗能力的影响

Epidemiology characteristics of acute traumatic spinal cord injury in primary hospitals and the impact of "group-based" intensive assistance on their diagnosis and treatment capacities

中文关键词:  创伤性脊髓损伤  流行病学  基层医院  “组团式”帮扶  诊疗能力

英文关键词:Traumatic spinal cord injury  Epidemiology  Primary hospital  "Group-based" assistance  Diagnosis and treatment capacity

中文摘要:

  【摘要】 目的：明确首诊于基层医院的急性创伤性脊髓损伤（traumatic spinal cord injury，TSCI）患者流行病学特征，探讨高水平三甲公立医院“组团式”紧密型帮扶对基层医院TSCI诊疗能力的提升作用。方法：采用回顾性分析，收集2016年1月～2022年12月首诊于化州市人民医院的252例TSCI患者临床资料，以2019年南方医科大学南方医院启动“组团式”紧密型帮扶为时间节点，分为帮扶前（2016～2018年，n=91）与帮扶后（2019～2022年，n=161）两组，对比两组患者流行病学特点（包括：性别、年龄、致伤原因、损伤部位、是否有合并其他外伤等）及诊疗相关指标变化（包括：手术率与功能改善率、是否住ICU及抢救等）。结果：252例患者中男性192例（76.19%），女性60例（23.81%），中位年龄为55.50（43.25，64.00）岁。主要致伤原因为高处坠落81例（32.14%）、车祸75例（29.76%）和低处坠落（＜2m）73例（28.97%）；最常见损伤部位为颈椎204例（80.95%）；75.00%（189/252）患者合并其他部位的损伤，其中32.93%（83/252）为多部位损伤。外伤至入院的中位时间为3.00（2.00，5.00）h。ASIA分级中D级占比最高（58.73%，148/252），帮扶后A级和B级患者占比从7.69%（7/91）升至25.47%（41/161）（P＜0.001）。帮扶前手术治疗率为6.59%（6/91），帮扶后提升至40.37%（65/161）（P＜0.001）；出院时神经功能改善率从34.07%（31/91）提高至54.66%（88/161）（P＜0.001）。其中救治A级与B级损伤人数比例在帮扶后显著提升，2016~2018年间，ASIA A级与B级总数为7例（7.69%），2019~2022年间增长至41例（25.47%）。帮扶前仅6例（6.59%）患者在基层医院进行手术治疗；帮扶后手术患者比例提升至65例（40.37%）。出院时神经功能改善率由帮扶前的34.07%（31例）提升至帮扶后的54.66%（88例）。结论：基层医院急性创伤性脊髓损伤（TSCI）患者以男性为主、中老年化，颈髓损伤及多发伤常见，坠落伤/车祸为主要致伤原因；高水平三甲医院“组团式”紧密型帮扶能显著提升基层医院TSCI综合救治能力。

英文摘要:

  【Abstract】 Objectives: To clarify the epidemiological characteristics of patients with acute traumatic spinal cord injury(TSCI) who were first diagnosed in primary hospitals, and to investigate the effect of "group-based" intensive assistance provided by high-level grade A tertiary public hospitals on improving the diagnosis and treatment capacity of primary hospitals for TSCI. Methods: A retrospective analysis was conducted on 252 TSCI patients who were first admitted to Huazhou People′s Hospital from January 2016 to December 2022. Taking the launch of "group-based" intensive assistance by Nanfang Hospital of Southern Medical University in 2019 as the time node, the patients were divided into two groups: pre-assistance group(2016-2018, n=91) and post-assistance group(2019-2022, n=161). The epidemiological characteristics of patients(including gender, age, causes of injury, injury sites, and presence of other concurrent traumatic injuries) as well as changes in diagnosis and treatment-related indicators(including surgical rate, functional improvement rate, ICU admission status, and rescue interventions) were compared between the two groups. Results: Among the 252 patients, 192 were male(76.19%) and 60 were female(23.81%), with a median age of 55.50(43.25, 64.00) years. The main causes of injury were falling from height(81 cases, 32.14%), traffic accidents(75 cases, 29.76%), and falling from low altitude(<2m, 73 cases, 28.97%). The most common injury site was cervical spine(204 cases, 80.95%). A total of 75.00%(189/252) of the patients were complicated with injuries in other parts, among which 32.93%(83/252) had multiple injuries. The median time from trauma to hospital admission was 3.00(2.00, 5.00)h. In terms of ASIA impairment scale, grade D accounted for the highest proportion(58.73%, 148/252). After the assistance, the proportion of patients with grade A and B increased from 7.69%(7/91) to 25.47%(41/161)(P<0.001). The surgical treatment rate increased from 6.59%(6/91) before assistance to 40.37%(65/161) after assistance(P<0.001); The neurological function improvement rate at discharge increased from 34.07%(31/91) to 54.66%(88/161)(P<0.001). Conclusions: TSCI patients in primary hospitals are predominantly male and tend to be middle aged or elderly, with cervical injuries and multiple trauma being common, mainly caused by falls and traffic accidents. The "group-based" intensive support from high level tertiary hospitals can significantly improve the comprehensive treatment capacity for TSCI in primary hospitals.