Hoyt David B, Coimbra Raul, Potenza Bruce, Doucet Jay, Fortlage Dale, Holingsworth-Fridlund Peg, Holbrook Troy
Division of Trauma, Department of Surgery, University of California San Diego, San Diego, California 92103-8896, USA.
J Trauma. 2003 Jan;54(1):26-36; discussion 36-7. doi: 10.1097/00005373-200301000-00004.
The development of trauma systems reduces preventable mortality and the measurement of standardized complications creates further opportunity for improvement in morbidity. The annual incidence of complications in a trauma population has been previously reported but the frequency change over time in a single institution is not well studied.
All patients who were hospitalized for more than 24 hours, who died, were admitted to the Intensive Care Unit (ICU) or Intermediate Care Unit (IMU), or were inter-facility transfers prospectively evaluated for 12 consecutive years. A total of 13,382 patients were studied (range, 862-1234 patients per year). Complication events were collected using 135 standardized definitions including disease and provider outcomes.
The overall incidence of complications has remained stable over time. Provider events, disease events, and patients developing three or more complications have remained unchanged as well. Specific disease complications including pneumonia, deep vein thrombosis (DVT), and small bowel obstruction have fallen over time. Improvements in provider errors have also occurred.
This data suggests that most complications have a finite threshold despite the use of a stable trauma staff, implementation of standardized protocols, and emphasis on consistency of practice. Further reductions will require new research for disease-related treatment and new strategies for consistency and error reduction rather than our current models of continuous quality improvement.
创伤系统的发展降低了可预防的死亡率，标准化并发症的衡量为降低发病率创造了更多机会。此前已有创伤人群并发症的年发病率报告，但单一机构中并发症随时间的频率变化尚未得到充分研究。
对连续12年住院时间超过24小时、死亡、入住重症监护病房（ICU）或中级护理病房（IMU）或进行机构间转运的所有患者进行前瞻性评估。共研究了13382例患者（每年862 - 1234例）。使用135个标准化定义收集并发症事件，包括疾病和医疗服务结果。
随着时间推移，并发症的总体发生率保持稳定。医疗服务事件、疾病事件以及出现三种或更多并发症的患者数量也保持不变。特定疾病并发症，如肺炎、深静脉血栓形成（DVT）和小肠梗阻，随时间有所下降。医疗服务失误也有所改善。
该数据表明，尽管有稳定的创伤医疗团队、实施标准化方案并强调实践的一致性，但大多数并发症仍有一个有限的阈值。进一步降低并发症需要针对疾病相关治疗的新研究以及提高一致性和减少失误的新策略，而非我们当前的持续质量改进模式。
