Résumé
Objectif
Décrire la prise en charge des traumatisés graves fermés dans les hôpitaux universitaires français.
Matériel et méthodes
L’étude FIRST (French Intensive care Recorded in Severe Trauma), a fait collaborer 14 CHU français. Le recueil des données épidémiologiques est prospectif, en phase préhospitalière et hospitalière sur les patients admis en réanimation dans les 72 heures post-traumatiques et/ou pris en charge par un Smur des CHU participants.
Résultats
La moyenne d’âge des patients est de 42 ± 18 ans. Soixante et un pour cent sont victimes d’un accident de la voie publique, 30 % d’un accident domestique ou sportif, 7 % d’un accident du travail et 2 % d’un autre traumatisme. Plus de la moitié des patients sont intubés en préhospitalier. Le score de Glasgow médian initial est de 12 ; IQR [6 ; 15]. À l’issue de la médicalisation préhospitalière, la pression artérielle moyenne passe de 83 ± 29 mmHg à 84 ± 23 mmHg. Le remplissage vasculaire moyen utilisé est de 788 ± 862 ml et 16 % des patients reçoivent des catécholamines avant l’admission hospitalière. Un quart des patients inclus passe par un centre hospitalier général avant leur admission en CHU et le délai médian d’admission au CHU augmente de 1,9 [1,3–25] heures à 6,5 [5,0–8,4] heures (p < 0,001). Près de 7 % des patients ne sont pas médicalisés en préhospitalier. La réalisation d’un scanner corps entier n’est pas systématique. La gravité lésionnelle (ISS médian 25 ; IQR [18 ; 34]) peut expliquer la durée médiane de séjour en réanimation de 7 jours; IQR 2–9 jours, durant laquelle 57 % d’entre eux présentent une complication infectieuse, et la mortalité à 30 jours de 23 %.
Conclusion
Cette étude montre que dans l’ensemble les recommandations sont bien suivies, et incite à la mise en place de réseaux de soins formalisés.
Abstract
Aim
The FIRST study (French Intensive care Recorded in Severe Trauma) was designed in order to describe the French management of severe blunt trauma in collaboration with 14 University hospitals.
Procedure
Epidemiological, clinical data of pre- and in-hospital evolution were prospectively recorded for 3090 patients admitted in ICU within 72 hours after trauma and/or managed by a prehospital medical team of a participant center.
Results
The mean age is 42 years old (SD 18), 61% of patients are road traffic victims, 30% are miscellaneous accidents victims (domestic, sports…) and 7% are involved in work accident and 2% in other type of accident.
More than 50% of patients are intubated during prehospital care. Median Coma Glasgow Score is 12; IQR [6; 15]. After prehospital management, mean arterial pressure evolves from 89 mmHg (SD 29) to 84 mmHg (SD 23). Mean prehospital fluid loading is 788 ± 862 ml and 16% of patients receive prehospital continuous catecholamine infusion.
Nearly 25% of patients are initially admitted in a general hospital before University hospital transfer. Such strategy increases delay admission to University hospital (1,9 hours, IQR [1,3–2,5 hours] to 6,4 hours, IQR [5,0–8,4 hours], p < 0,001. Many patients were not managed by a medical prehospital team (7%) and whole-body CT on admission is not systematically performed. The injury severity score (median ISS: 25; IQR [18; 34]) may explain the time stay in intensive care unit (7 days), IQR [2–19 days] where 57% of patients have sepsis complications, and the global mortality of 23% at the 30th day.
Conclusion
This study shows that all recommendations are well followed and promotes the installation of formalized regional care systems.
Article PDF
Avoid common mistakes on your manuscript.
Références
Sethi D, Racioppi F, Baumgarten I, Bertollini R (2006) Reducing inequalities from injuries in Europe. Lancet 368:2243–2250
Champion HR, Copes WS, Sacco WJ, et al (1990) The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma 30:1356–1365
Nathens AB, Brunet FP, Maier RV (2004) Development of trauma systems and effect on outcomes after injury. Lancet 363:1794–1801
Cayten CG, Stahl WM, Byrne D, Murphy JG (1991) A comparison of diagnostic related group length of stay outliers: motor vehicle crash versus penetrating injuries. Accid Anal Prev 23:317–322
Tiret L, Hausherr E, Thicoïpé M, et al (1990) The epidemiology of head trauma in Aquitaine (France), 1986: a community-based study of hospital admissions and deaths. Int J Epidemiol 19: 133–1340
Tiret L, Garros B, Maurette P, et al (1989) Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths. Am J Public Health 1989 79:316–321
Amoros E, Martin JL, Laumon B (2007) Estimating non-fatal road casualties in a large French county, using the capture-recapture method. Accid Anal Prev 39:483–490
Nguyen-Thanh Q, Tresallet C, Langeron O, et al (2003) Les polytraumatismes sont plus graves après chute d’une grande hauteur qu’après accident de la voie publique. Ann Chir 128:526–529
Yeguiayan JM, Garrigue D, Binquet C, et al (2011) Medical prehospital management reduces mortality in severe blunt trauma: a prospective epidemiological study. Crit Care 15:R34
Vivien B, Yeguiayan JM, Le Manach Y, et al (2011) The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients. Am J Emerg Med (in press)
Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196
Stiell IG, Nesbitt LP, Pickett W, et al (2008) The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ 178:1141–1152
Sartorius D, Le Manach Y, David JS, et al (2010) Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP): A new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med 38:831–837
Riou B, Carli P, Thicoïpé M, Atain-Kouadio P (2003) Comment évaluer la gravité. In: Le traumatisé grave, Journées scientifiques de SAMU de France, Vittel 2002, SFEM Ed., Paris, 113–128
Eckstein M, Chan L, Schneir A, Palmer R (2000) Effect of prehospital advanced life support on outcomes of major trauma patients. J Trauma 48:643–648
Baxt WG, Moody P (1987) The impact of advanced prehospital emergency care on the mortality of severely brain-injured patients. J Trauma 27:365–369
Haas B, Nathens AB (2008) Pro/con debate: is the scoop and run approach the best approach to trauma services organization? Crit Care 12:224
Osterwalder JJ (2002) Can the “golden hour of shock” safely be extended in blunt polytrauma patients? Prospective cohort study at a level I hospital in eastern Switzerland. Prehosp Disaster Med 17:75–80
MacKenzie EJ, Rivara FP, Jurkovich GJ, et al (2006) A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 354:366–378
Osterwalder JJ (2002) Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A prospective cohort study. J Trauma 52:1030–1036
Cardoso LT, Grion CM, Matsuo T, et al (2011) Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care 15:R28
Freysz M, Yeguiayan JM (2007) Evaluation de la gravité et recherche des complications précoces. Rev Prat 57:441–452
Spahn DR, Cerny V, Coats TJ, et al (2007) Management of bleeding following major trauma: a European guideline. Crit Care 11:R17
Riou B, Landais P, Vivien B, et al (2001) Distribution of the probability of survival is a strategic issue for randomized trials in critically ill patients. Anesthesiology 95:56–63
Lenfant F, Sobraques P, Nicolas F, et al (1997) Utilisation par des internes d’anesthésie-réanimation du score de Glasgow chez le traumatisé crânien. Ann Fr Anesth Réanim 16:239–243
Tien HC, Cunha JR, Wu SN, et al (2006) Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival? J Trauma 60:274–278
Boulard G, Cantagrel S (1999) Prise en charge des traumatises crâniens graves à la phase précoce. Agence Nationale d’Accréditation et d’Evaluation en Santé (ANAES). Presse Med 1999 28:793–798
Davis DP, Dunford JV, Poste JC, et al (2004) The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma 57:1–8
Raux M, Thicoïpé M, Wiel E, et al (2006) Comparison of respiratory rate and peripheral oxygen saturation to assess severity in trauma patients. Intensive Care Med 32:405–412
Huber-Wagner S, Lefering R, Qvick LM, et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461
Dumont TM, Visioni AJ, Rughani AI, et al (2010) Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma. 27:1233–1241
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Yeguiayan, J.M., Garrigue, D., Binquet, C. et al. Prise en charge actuelle du traumatisé grave en France : premier bilan de l’étude FIRST (French Intensive care Recorded in Severe Trauma). Ann. Fr. Med. Urgence 2, 156–163 (2012). https://doi.org/10.1007/s13341-012-0181-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13341-012-0181-1
Mots clés
- Médecine d’urgence
- Étude épidémiologique
- Samu/Smur
- Traumatisme grave fermé
- Réanimation préhospitalière
- Réanimation