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在1级和2级创伤中心的病例数量变化的评估和影响

Patrick L Johnson^1,2, Bryant W Oliphant^2,3, Jonathan E Williams^1,2

¹From the Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.

Annals of surgery open : perspectives of surgical history, education, and clinical approaches

|June 25, 2025

概括

创伤中心病例数量有很大差异,影响了患者的护理和技能. 低体积中心执行的基本程序较少,表明潜在的实践变化.

科学领域:

创伤外科手术创伤外科
医疗保健系统分析医疗保健系统分析
提高质量提高质量

背景情况:

创伤中心的分布必须与区域需求保持一致,以保持体积与结果的关系.
病例体积的变化影响创伤中心的分布,患者的结果和技能维护.

研究的目的:

评估美国一级和二级创伤中心患者病例数量和程序数量的变化.
评估创伤护理中程序量和病例量之间的关系.

主要方法:

创伤中心根据满足美国外科外科学院创伤质量改善计划 (ACS TQIP) 标准的平均年度患者数量 (2017-2021) 划分为五分之一.
分析了不同病例数量和创伤中心验证水平的患者特征和程序.
检查了与潜在指示相对执行程序的比例,以评估与案件数量相关的程序数量.

主要成果:

分析包括来自228个1级和288个2级创伤中心的1,902,005名患者.
在ACS TQIP合格患者数量中,在1级和2级创伤中心的最高和最低五分之一之间观察到四倍的差异.
最低五分位数的中心进行了最小的基本手术 (例如,每年22次出血控制,每年10次骨盆骨折手术);低体积的中心进行的手术比例较少 (例如,低血压/心跳动患者的出血控制:25.9%与31.8%,P<0.001).

结论:

创伤中心病例数量存在显著差异,20%的1级中心平均每月不到两次出血控制手术.
低体积的创伤中心进行的手术比例较少,这表明临床实践模式的不明原因变化.

关键词:

创伤网络创伤网络创伤网络创伤系统创伤系统

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