O'Keefe G E, Jurkovich G J, Copass M, Maier R V
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9158, USA.
Ann Surg. 1999 Mar;229(3):409-15. doi: 10.1097/00000658-199903000-00015.
To determine the impact of increasing trauma center experience over time on survival and resource utilization.
The authors studied a retrospective cohort at a single level I trauma center over a 10-year period, from 1986 to 1995. Patients included all hospital admissions and emergency department deaths. The main outcome measures were the case-fatality rate adjusted for injury severity, hospital length of stay, and costs.
A total of 25,979 patients were admitted or died. The number of patients per year increased, from 2063 in 1986 to 3313 in 1995. The proportion of patients transferred from another institution increased from 16.2% to 34.4%. Although mean length of stay declined by 28.4%, from 9.5 to 6.8 days, costs increased by 16.7%, from $14,174 to $16,547. The use of specific radiologic investigations increased; the frequency of operative procedures either remained unchanged (craniotomy, fracture fixation) or decreased (celiotomy). After adjusting for injury severity and demographic factors, the mortality rate decreased over 10 years. The improvement in survival was confined to patients with an injury severity score > or =16.
Over a 10-year period, the case-fatality rate declined in patients with severe injuries. Overall acute care costs increased, partially because of the increased use of radiologic investigations. Even in otherwise established trauma centers, increasing cumulative experience results in improved survival rates in the most severely injured patients. These data suggest that experience contributes to a decrease in mortality rate after severe trauma and that developing trauma systems should consider this factor and limit the number of designated centers to maximize cumulative experience at individual centers.
确定随着时间推移创伤中心经验的增加对生存率和资源利用的影响。
作者研究了1986年至1995年这10年间单一的I级创伤中心的回顾性队列。患者包括所有住院患者和急诊科死亡患者。主要结局指标为根据损伤严重程度调整后的病死率、住院时间和费用。
共有25979名患者入院或死亡。每年的患者数量有所增加，从1986年的2063例增至1995年的3313例。从其他机构转入的患者比例从16.2%增至34.4%。尽管平均住院时间下降了28.4%，从9.5天降至6.8天，但费用增加了16.7%，从14174美元增至16547美元。特定放射学检查的使用增加；手术操作的频率要么保持不变（开颅手术、骨折固定），要么下降（剖腹手术）。在调整损伤严重程度和人口统计学因素后，10年间死亡率下降。生存率的提高仅限于损伤严重程度评分≥16的患者。
在10年期间，重伤患者的病死率下降。总体急性护理费用增加，部分原因是放射学检查使用的增加。即使在其他方面已成熟的创伤中心，累积经验的增加也会使最重伤患者的生存率提高。这些数据表明，经验有助于降低严重创伤后的死亡率，并且发展创伤系统应考虑这一因素，并限制指定中心的数量，以最大限度地提高各个中心的累积经验。
