Farrell Louise Szypulski, Hannan Edward L, Cooper Arthur
Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, Rensselaer, NY 12144-3456, USA.
Pediatr Crit Care Med. 2004 Jan;5(1):5-9. doi: 10.1097/01.PCC.0000102223.77194.D7.
To a) compare in-hospital mortality rates for pediatric (age <13 yrs) patients with blunt injuries in the New York State Trauma Registry based on hospital type (dedicated pediatric intensive care unit [PICU] and designated trauma centers and noncenters that do not have a dedicated PICU) for the purpose of determining whether there is a reduction in mortality at a specialty hospital and b) determine the extent to which high-risk patients are admitted to specialty hospitals.
Inpatient data for the years 1994-1998 in the New York State Trauma Registry.
A total of 8,180 pediatric inpatients who suffered blunt injury were selected to examine where patients were treated (PICU, regional trauma center without PICU, area trauma center without PICU, or noncenter without PICU) as a function of injury severity.
Data were extracted for inpatients aged <13 yrs who suffered blunt injury.
The injury severity of inpatients treated at PICUs and regional centers without PICUs was significantly higher than at other hospitals. Risk factors that were independently related to survival of pediatric trauma inpatients were age <5 yrs, motor component of one to five, abnormal systolic blood pressure relative to age, and International Classification of Disease, Ninth Revision-Based Injury Severity Score. Of the total 136 deaths, 133 were among the patients <5 yrs old, motor score <6, and age-related abnormal systolic blood pressure. A total of 66.8% of these patients were treated at PICUs, and 9.9% were treated at regional centers without PICUs. No statistically significant differences in risk-adjusted mortality rates were found by hospital type, but rates at PICUs were lower than for other types of hospitals except for noncenters without PICUs, whose patients were considerably less severely injured.
There is significant triaging of the most seriously injured pediatric trauma inpatients to PICUs, and there is evidence that this policy is effective.
a）基于医院类型（设有专门儿科重症监护病房[PICU]的医院、指定创伤中心以及未设专门PICU的非创伤中心），比较纽约州创伤登记处中儿科（年龄<13岁）钝性伤患者的院内死亡率，以确定专科医院的死亡率是否有所降低；b）确定高危患者入住专科医院的比例。
纽约州创伤登记处1994 - 1998年的住院患者数据。
共选取8180例遭受钝性伤的儿科住院患者，根据损伤严重程度检查患者的治疗地点（PICU、无PICU的区域创伤中心、无PICU的地区创伤中心或无PICU的非中心医院）。
提取年龄<13岁且遭受钝性伤的住院患者的数据。
在设有PICU的医院和未设PICU的区域中心接受治疗的住院患者的损伤严重程度显著高于其他医院。与儿科创伤住院患者生存独立相关的危险因素为年龄<5岁、运动评分1至5分、相对于年龄的收缩压异常以及基于《疾病和有关健康问题的国际统计分类》第九版的损伤严重度评分。在总共136例死亡病例中，133例为年龄<5岁、运动评分<6分且存在与年龄相关的收缩压异常的患者。这些患者中，66.8%在PICU接受治疗，9.9%在未设PICU的区域中心接受治疗。按医院类型分析，风险调整后的死亡率无统计学显著差异，但PICU的死亡率低于其他类型医院，不过未设PICU的非中心医院患者的损伤程度要轻得多。
最严重受伤的儿科创伤住院患者被大量分诊至PICU，且有证据表明该政策是有效的。
