Peleg Kobi, Aharonson-Daniel Limor, Stein Michael, Kluger Yoram, Michaelson Moshe, Rivkind Avraham, Boyko Valentina
Author Affiliations: Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel.
Arch Surg. 2004 Nov;139(11):1231-6. doi: 10.1001/archsurg.139.11.1231.
The survival of severe trauma patients is affected by the implementation of a national trauma system, which brought about developments both at the hospital and prehospital levels during the past decade.
A retrospective cohort study of all severely injured patients (Injury Severity Score >16) recorded in the Israeli National Trauma Registry at all level I trauma centers in Israel from January 1, 1997, to December 31, 2001. Inpatient death rates were examined overall and by subgroups.
The National Trauma Registry includes trauma (International Statistical Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 800-959) hospitalizations, patients who were transferred to or from other hospitals, and those who died in the emergency department. It excludes patients who were dead on arrival, discharged following treatment in the emergency department, and patients who do not fall into the definition of trauma. Main Outcome Measure Inpatient death.
Seven thousand four hundred twenty-three severe trauma patients were recorded. Inpatient death rates decreased significantly from 21.6% in 1997 to 14.7% in 2001. The odds ratios of mortality in 1998 through 2001 vs 1997, adjusted for year, age, sex, penetrating injury, and severity of injury (Injury Severity Score >25), were 0.92, 0.89, 0.70, and 0.65, respectively, confirming the downward trend.
A steady significant reduction in the inpatient death rate of severe trauma patients hospitalized at all level I trauma centers in Israel between 1997 and 2001 was observed. Although a single factor that explains the reduction was not identified, it is evident that the establishment of the trauma system brought about a significant decrease in mortality. We believe that integrated cooperation of various components of the national trauma system in Israel across the years may explain the reduction.
国家创伤系统的实施会影响严重创伤患者的生存率，在过去十年中，该系统在医院和院前层面都带来了发展。
对1997年1月1日至2001年12月31日期间以色列所有一级创伤中心记录在以色列国家创伤登记处的所有重伤患者（损伤严重度评分>16）进行回顾性队列研究。总体及按亚组检查住院死亡率。
国家创伤登记处包括创伤（国际疾病分类第九版，临床修订诊断编码800 - 959）住院患者、转至或转出其他医院的患者以及在急诊科死亡的患者。它不包括到达时已死亡的患者、在急诊科治疗后出院的患者以及不属于创伤定义范围的患者。主要结局指标为住院死亡。
记录了7423例严重创伤患者。住院死亡率从1997年的21.6%显著下降至2001年的14.7%。1998年至2001年与1997年相比，经年份、年龄、性别、穿透伤和损伤严重程度（损伤严重度评分>25）调整后的死亡比值比分别为0.92、0.89、0.70和0.65，证实了下降趋势。
观察到1997年至2001年期间，以色列所有一级创伤中心收治的严重创伤患者的住院死亡率持续显著下降。虽然未确定导致下降的单一因素，但显然创伤系统的建立使死亡率显著降低。我们认为，多年来以色列国家创伤系统各组成部分的综合合作可能解释了这一下降情况。
