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Abstract：
BACKGROUND: Pre-hospital anaesthesia is a core competency of helicopter emergency medical services (HEMS). Whether physician pre-hospital anaesthesia case volume affects outcomes is unknown in this setting. We aimed to investigate whether physician case volume was associated with differences in mortality or medical management.
METHODS: We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0-12), intermediate (13-36), and high (≥37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension.
RESULTS: In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64-0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th-75th percentile: 22-38], compared with intermediate 32 [23-42] and lowest 32 [23-43] case-volume groups; P<0.001) and a higher first-pass success rate for tracheal intubation (98%, compared with 93% and 90%, respectively; P<0.001). The incidence of hypoxaemia and hypotension was similar between groups.
CONCLUSIONS: Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.
METHODS: We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0-12), intermediate (13-36), and high (≥37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension.
RESULTS: In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64-0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th-75th percentile: 22-38], compared with intermediate 32 [23-42] and lowest 32 [23-43] case-volume groups; P<0.001) and a higher first-pass success rate for tracheal intubation (98%, compared with 93% and 90%, respectively; P<0.001). The incidence of hypoxaemia and hypotension was similar between groups.
CONCLUSIONS: Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.
摘要：
背景：院前麻醉是直升机紧急医疗服务（HEMS）的核心能力。在这种情况下，医师院前麻醉病例量是否会影响结果尚不清楚。我们旨在调查医师病例量是否与死亡率或医疗管理差异相关。
方法：我们从2013年1月1日至2019年8月31日，对HEMS医师进行药物促进插管的患者进行了一项基于注册的队列研究。主要结果是30天死亡率，使用多变量逻辑回归控制患者依赖变量进行分析。每位患者的病例量由主治医师在过去12个月中管理的院前麻醉剂的数量确定。解释变量是按低位(0-12)分组的医师病例量，中间（13-36），和高（≥37）病例体积。次要结果是医疗管理的特征，包括低氧血症和低血压的发生率。
结果：在4818例患者中，医生病例量为511、2033和2274名患者，中介-，和大量病例组，分别。较高的医师病例量与较低的30天死亡率相关(每对数病例数比值比0.79[95%置信区间:0.64-0.98])。大量医师提供者的现场时间较短（中位数28[第25-75百分位数：22-38]，与中等32[23-42]和最低32[23-43]例容量组相比；P<0.001）和更高的气管插管首过成功率（98％，与93%和90%相比，分别；P<0.001)。两组之间低氧血症和低血压的发生率相似。
结论：院前麻醉后，病死率似乎较低，由具有较高病例量的医师提供者提供。
方法：我们从2013年1月1日至2019年8月31日，对HEMS医师进行药物促进插管的患者进行了一项基于注册的队列研究。主要结果是30天死亡率，使用多变量逻辑回归控制患者依赖变量进行分析。每位患者的病例量由主治医师在过去12个月中管理的院前麻醉剂的数量确定。解释变量是按低位(0-12)分组的医师病例量，中间（13-36），和高（≥37）病例体积。次要结果是医疗管理的特征，包括低氧血症和低血压的发生率。
结果：在4818例患者中，医生病例量为511、2033和2274名患者，中介-，和大量病例组，分别。较高的医师病例量与较低的30天死亡率相关(每对数病例数比值比0.79[95%置信区间:0.64-0.98])。大量医师提供者的现场时间较短（中位数28[第25-75百分位数：22-38]，与中等32[23-42]和最低32[23-43]例容量组相比；P<0.001）和更高的气管插管首过成功率（98％，与93%和90%相比，分别；P<0.001)。两组之间低氧血症和低血压的发生率相似。
结论：院前麻醉后，病死率似乎较低，由具有较高病例量的医师提供者提供。
