Pasquale M D, Peitzman A B, Bednarski J, Wasser T E
Department of Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
J Trauma. 2001 Mar;50(3):465-72; discussion 473-4. doi: 10.1097/00005373-200103000-00010.
The purpose of this study was to evaluate the impact of five trauma center characteristics on survival outcome in nine serious injury categories.
A retrospective analysis of prospectively collected data from 1992 to 1996 on patients older than 14 years of age from 24 accredited trauma centers in Pennsylvania was performed. Trauma center characteristics selected for evaluation were level of accreditation, volume of trauma admissions, presence of in-house trauma surgeons, presence of a surgical residency program, and presence of an on-site medical school. Each of these characteristics was evaluated to determine its impact on survival in the selected serious injuries. A logistic regression model was then created to evaluate the most seriously injured patients as defined by A Severity Characterization of Trauma score of < 0.50. On the basis of the logistic regression model, odd ratios were calculated treating low volume as a significant risk factor for mortality.
Of the 88,723 patients meeting registry criteria, 13,942 met the serious injury criteria. Independent analysis suggested that accreditation was beneficial regardless of level, volume of patients treated had a direct impact on survival outcome, and the presence of a surgical residency program may confer survival benefit. Of the 13,942 patients with serious injuries, those with A Severity Characterization of Trauma score of < 0.5 were selected for evaluation by logistic regression (n = 3,562). The logistic regression model, however, showed that only volume of patients treated had a consistent association with improved survival. Odds ratio analysis revealed low volume as a significant risk factor for mortality in seven of the nine injuries studied.
In this analysis, only volume of patients treated had a direct impact on survival outcome. Accreditation, regardless of level, appears to be beneficial.
本研究旨在评估五个创伤中心特征对九种严重损伤类型患者生存结局的影响。
对1992年至1996年从宾夕法尼亚州24家经认可的创伤中心前瞻性收集的14岁以上患者的数据进行回顾性分析。选择用于评估的创伤中心特征包括认可级别、创伤入院量、内部创伤外科医生的配备、外科住院医师培训项目的存在以及现场医学院的存在。对这些特征中的每一项进行评估，以确定其对所选严重损伤患者生存的影响。然后创建一个逻辑回归模型，以评估创伤严重程度评分（AST）<0.50定义的最严重受伤患者。基于逻辑回归模型，将低入院量作为死亡率的一个重要风险因素来计算比值比。
在符合登记标准的88,723例患者中，13,942例符合严重损伤标准。独立分析表明，无论认可级别如何，认可都是有益的，治疗患者的数量对生存结局有直接影响，并且外科住院医师培训项目的存在可能带来生存益处。在13,942例严重受伤患者中，选择创伤严重程度评分<0.5的患者通过逻辑回归进行评估（n = 3,562）。然而，逻辑回归模型显示，只有治疗患者的数量与生存率提高有一致的关联。比值比分析显示，在所研究的九种损伤中的七种中，低入院量是死亡率的一个重要风险因素。
在本分析中，只有治疗患者的数量对生存结局有直接影响。无论认可级别如何，认可似乎都是有益的。
