Shafi Shahid, Nathens Avery B, Elliott Alan C, Gentilello Larry
Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, University of Texas Southwestern Medical School, Dallas, Texas 75390-9158, USA.
J Trauma. 2006 Dec;61(6):1374-8; discussion 1378-9. doi: 10.1097/01.ta.0000246698.07125.c0.
Population-based studies using a "before-and-after" methodology report a reduction in motor vehicle collision mortality with implementation of statewide trauma systems (TS). However, concurrent improvements in roads, cars, restraint systems, and changes in rates of drunk driving, socioeconomics, speed limits, urban or rural mix, and traffic density may also be responsible for the progressive reduction in mortality rates. We hypothesized that a statewide TS independently reduces injury mortality, irrespective of other factors.
Data were acquired from several federal agencies including the Centers for Disease Control (CDC), The National Highway Traffic Safety Administration (NHTSA), the United States Department of Transportation (DOT), and the United States Census Bureau. Age-adjusted motor vehicle occupant (MVO) death rates per 100,000 population were compared in states with and without a TS. Negative binomial regression was used to calculate risk ratios (RR) comparing mortality in TS and non-TS states after adjusting for effects of gender, race, primary seat belt laws, seat belt use, alcohol use, miles traveled, population density, per capita income, types of registered vehicles, and rural or urban mix.
: The number of states with a TS increased from 7 in 1981 to 36 in 2002. Concurrently, nationwide MVO death rates decreased by 2.6 per 100,000 (95% confidence interval 1.2-3.9; p < 0.001). Income, primary seat belt laws, restraint use, speed limits, and rural or urban population distribution (p < 0.05 for all), were independent predictors of MVO mortality, but not presence of a TS (RR 0.95, 95% confidence interval 0.73-1.23; p = 0.68).
MVO death rates have declined over time, and are lower in TS states. However, the cause is multi-factorial, and cannot be attributed solely to presence of TS. Further studies are needed to identify beneficial components of a statewide trauma system.
采用“前后对比”方法的基于人群的研究报告称，随着全州创伤系统（TS）的实施，机动车碰撞死亡率有所下降。然而，道路、汽车、约束系统的同步改善，以及酒驾率、社会经济状况、限速、城乡混合比例和交通密度的变化，也可能是死亡率逐步下降的原因。我们假设，全州创伤系统能独立降低伤害死亡率，而不受其他因素影响。
数据来自多个联邦机构，包括疾病控制中心（CDC）、国家公路交通安全管理局（NHTSA）、美国运输部（DOT）和美国人口普查局。比较了有创伤系统和没有创伤系统的州中，每10万人口的年龄调整机动车驾乘人员（MVO）死亡率。在调整了性别、种族、主要安全带法律、安全带使用情况、酒精使用情况、行驶里程、人口密度、人均收入、注册车辆类型以及城乡混合比例的影响后，使用负二项回归计算风险比率（RR），以比较创伤系统州和非创伤系统州的死亡率。
拥有创伤系统的州数量从1981年的7个增加到2002年的36个。与此同时，全国机动车驾乘人员死亡率每10万人下降了2.6例（95%置信区间1.2 - 3.9；p < 0.001）。收入、主要安全带法律、约束装置使用、限速以及城乡人口分布（所有p < 0.05）是机动车驾乘人员死亡率的独立预测因素，但创伤系统的存在不是（RR 0.95，95%置信区间0.73 - 1.23；p = 0.68）。
机动车驾乘人员死亡率随时间下降，且在有创伤系统的州更低。然而，原因是多因素的，不能仅归因于创伤系统的存在。需要进一步研究以确定全州创伤系统的有益组成部分。
