Nathens A B, Jurkovich G J, Rivara F P, Maier R V
Department of Surgery, Harborview Medical Center, University of Washington, Seattle 98104, USA.
J Trauma. 2000 Jan;48(1):25-30; discussion 30-1. doi: 10.1097/00005373-200001000-00005.
Regional trauma systems were proposed 2 decades ago to reduce injury mortality rates. Because of the difficulties in evaluating their effectiveness and the methodologic limitations of previously published studies, the relative benefits of establishing an organized system of trauma care remains controversial.
Data on trauma systems were obtained from a survey of state emergency medical service directors, review of state statutes and a previously published trauma system inventory. Injury mortality rates were obtained from national vital statistics data, whereas motor vehicle crash (MVC) mortality rates were obtained from the Fatality Analysis Reporting System. Mortality rates were compared between states with and without trauma systems.
As of 1995, 22 states had regional trauma systems. States with trauma systems had a 9% lower crude injury mortality rate than those without. When MVC-related mortality was evaluated separately, there was a 17% reduction in deaths. After controlling for age, state speed laws, restraint laws, and population distribution, there remained a 9% reduction in MVC-related mortality rate in states with a trauma system.
These data demonstrate that a state trauma system is associated with a reduction in the risk of death caused by injury. The effect is most evident on analysis of MVC deaths.
20年前提出了区域创伤系统以降低损伤死亡率。由于评估其有效性存在困难以及先前发表研究的方法学局限性,建立有组织的创伤护理系统的相对益处仍存在争议。
创伤系统的数据来自对州紧急医疗服务主任的调查、州法规审查以及先前发表的创伤系统清单。损伤死亡率来自国家生命统计数据,而机动车碰撞(MVC)死亡率来自死亡分析报告系统。比较了有创伤系统和没有创伤系统的州之间的死亡率。
截至1995年,22个州拥有区域创伤系统。有创伤系统的州的粗损伤死亡率比没有的州低9%。当单独评估与MVC相关的死亡率时,死亡人数减少了17%。在控制了年龄、州速度法律、安全带法律和人口分布后,有创伤系统的州的与MVC相关的死亡率仍降低了9%。
这些数据表明,州创伤系统与降低损伤导致的死亡风险相关。这种效果在对MVC死亡的分析中最为明显。