创伤中心体积与结果之间的关系
A B Nathens1, G J Jurkovich, R V Maier
1Harborview Medical Center, Box 359796, 325 Ninth Ave, Seattle, WA 98104-2499, USA. anathens@u.washington.edu
JAMA
|March 20, 2001
概括
更高的创伤中心体积显著改善了严重受伤患者的结果. 创伤中心每年有650多人入院,死亡率降低,住院时间缩短,特别是重伤患者.
科学领域:
- 创伤外科 手术 创伤外科
- 医疗保健服务研究 医疗服务研究
- 患者的治疗结果.
背景情况:
- 创伤护理的区域化旨在通过将患者集中在大量的中心来改善结果.
- 机构创伤量与患者结果之间的关系尚未确定.
研究的目的:
- 调查创伤中心体积与患者结果之间的关联.
- 为了确定更高的创伤中心体积是否与改善的生存率和减少住院时间有关.
主要方法:
- 这是一项回顾性队列研究,涉及美国31个学术一级或二级创伤中心.
- 对连续患有透腹部损伤 (PAI) 或多系统重创伤的患者进行分析.
- 结果 (住院死亡率,住院时间) 的比较:大批量 (>650人/年) 和小批量 (<=650人/年) 的中心.
主要成果:
- 高体积中心的死亡几率显著降低,对于震惊的PAI患者 (OR 0.02) 和昏迷的多系统形创伤患者 (OR 0.49).
- 在不严重受伤的患者 (没有休克或昏迷) 中,没有观察到显著的死亡益处.
- 在严重受伤的PAI患者和所有多系统形创伤患者的高体积中心,观察到更短的住院时间 (LOS).
结论:
- 创伤中心每年超过650例的病例数量与改善的死亡率和减少的LOS密切相关.
- 这些好处在需要重症监护的高风险创伤患者中最为明显.
- 研究结果支持创伤护理的区域化,将其转化为针对特定患者群体的大量中心.
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