Harbrecht Brian G, Zenati Mazen S, Ochoa Juan B, Townsend Ricard N, Puyana Juan C, Wilson Mark A, Peitzman Andrew B
Department of Surgery, University of Pittsburgh Medical Center, F1264-200 Lothrop Street, Pittsburgh, PA 15213, USA.
J Am Coll Surg. 2004 Feb;198(2):232-9. doi: 10.1016/j.jamcollsurg.2003.10.007.
The factors important in determining outcome when managing adult blunt splenic injuries continue to be debated. Whether trauma center level designation (Level I versus Level II) affects patient management has not been evaluated.
We conducted a retrospective analysis of prospectively gathered data from the Pennsylvania Trauma Outcome Study database that collected information from 27 statewide trauma centers (Level I [15], Level II [17]). Adult patients (ages > or = 16 years) with blunt splenic injuries (ICD-9-CM 865) were evaluated. Demographic data, injury data, and trauma center level designation were collected, and patient management, length of stay, and mortality were analyzed.
There were 2,138 adult patients who suffered blunt splenic injuries during the study period (1998-2000). Patients treated at Level II trauma centers (n = 772) had a higher rate of operative treatment (38.2% versus 30.7%) (p < 0.001), but a shorter mean length of stay (10.1 +/- 0.4 versus 12.0 +/- 0.4 days) (p < 0.01) compared with patients in Level I trauma centers (n = 1,366). The rate of failure of nonoperative treatment was lower at Level II trauma centers (13.0% versus 17.6%) (p < 0.05), but the mortality for patients managed nonoperatively was higher (8.4% versus 4.5%) (p < 0.05). Splenorrhaphy was performed more frequently in Level I trauma centers.
Management differences exist in the treatment of adult blunt splenic injuries between institutions of different trauma center level designation. Multicenter studies should account for this finding in design and implementation.
在处理成人钝性脾损伤时，决定治疗结果的重要因素仍存在争议。创伤中心级别认定（一级与二级）是否会影响患者的治疗尚未得到评估。
我们对宾夕法尼亚创伤结果研究数据库中前瞻性收集的数据进行了回顾性分析，该数据库收集了来自全州27家创伤中心（一级[15家]，二级[17家]）的信息。对成年钝性脾损伤患者（国际疾病分类第九版临床修订本[ICD - 9 - CM]编码865）进行评估。收集人口统计学数据、损伤数据和创伤中心级别认定信息，并分析患者治疗情况、住院时间和死亡率。
在研究期间（1998 - 2000年），有2138例成年患者遭受钝性脾损伤。与一级创伤中心的患者（n = 1366）相比，二级创伤中心（n = 772）治疗的患者手术治疗率更高（38.2%对30.7%）（p < 0.001），但平均住院时间更短（10.1 ± 0.4天对12.0 ± 0.4天）（p < 0.01）。二级创伤中心非手术治疗失败率较低（13.0%对17.6%）（p < 0.05），但非手术治疗患者的死亡率更高（8.4%对4.5%）（p < 0.05）。脾修补术在一级创伤中心更频繁实施。
不同创伤中心级别认定的机构在成人钝性脾损伤治疗方面存在管理差异。多中心研究在设计和实施时应考虑这一发现。
