Neely K W, Norton R L, Bartkus E, Schiver J A
Division of Emergency Medicine, Oregon Health Sciences University, Portland.
Prehosp Disaster Med. 1991 Oct-Dec;6(4):455-8. doi: 10.1017/s1049023x00038954.
Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH).
A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiography (ANG); anesthesiologist (ANE); intensive care unit (ICU); on-call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry.
With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS, and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p less than .01).
In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability can be performed in other communities to help guide trauma center designation.
教学医院（TH）比社区医院（CH）更能始终如一地维持美国外科医师学会创伤委员会（ACSCOT）的二级创伤护理标准。
对2091例创伤系统患者进行回顾性分析，以确定市区的教学医院是否比社区医院更能满足二级创伤护理标准。在研究期间，五家医院（两家教学医院和三家社区医院）实施了一项自愿创伤计划。只要医院当时能够提供ACSCOT规定的资源，就可以接收符合创伤系统入院标准的患者。医院需要准确报告其当前资源。一个中央通信中心维护着一个计算机化的医院间链接，持续监测所有参与医院的资源可用性。创伤系统协议要求护理人员将系统患者转运至最近的具备所有所需资源的创伤医院。针对每个机构的急诊科（ED）、创伤外科医生（TS）、手术室（OR）、血管造影（ANG）、麻醉师（ANE）、重症监护病房（ICU）、值班外科医生（OCS）、神经外科医生（NS）以及每次创伤系统入院时可用的CT扫描仪（CT），监测了ACSCOT二级创伤中心标准中的九项。
除手术室（OR）外，教学医院（TH）通常比社区医院（CH）更成功地维持了所需的人员和服务。此外，教学医院（TH）可用资源的昼夜变化较小。具体而言，教学医院（TH）在白天和晚上比社区医院（CH）更常提供麻醉师（ANE）、重症监护病房（ICU）、创伤外科医生（TS）、神经外科医生（NS）和CT扫描仪（CT）。然而，教学医院（TH）在白天和晚上的手术室（OR）可用性均低于社区医院（CH）（p<0.01）。
在这个社区中，教学医院（TH）比社区医院（CH）提供了更多的创伤服务。本研究支持将教学医院指定为创伤中心。其他社区也可以进行类似的可用性评估，以帮助指导创伤中心的指定。
