Martin Berni T, Fallon William F, Palmieri Patrick A, Tomas Ervin R, Breedlove Linda
Division of Trauma, Department of Surgery, Akron City Hospital, Akron, OH 44309, USA.
J Trauma. 2007 Jan;62(1):69-73; discussion 73. doi: 10.1097/TA.0b013e31802d08e5.
The value of autopsy findings has been questioned in peer review at mature trauma centers. We sought to determine the impact of autopsy data on the peer-review process.
This was a retrospective study. Data analyzed included mortality type (immediate/dead on arrival [DOA]; early [< or =48 hours]; late [>48 hours]), Injury Severity Scale (ISS) score, Trauma and Injury Severity Score-generated probability of survival (PS), peer-review judgment of preventability, and findings at autopsy. Deaths were assigned to a category; then pre- and postautopsy ISS score, PS, and outcomes of the peer- review process (percent nonpreventable [%NP]) were compared. Paired t tests (alpha = 0.05) were performed to determine whether changes in ISS score and PS were statistically significant. All descriptive and inferential analyses were based on cases with pre- and postautopsy data for the relevant variables.
Of the 170 deaths, 126 deaths had an autopsy performed (74.1%) and 112 autopsy reports were available (89.9%). Autopsy data resulted in statistically significant changes in ISS score for each mortality category and in PS for the immediate/DOA and early categories. There were also autopsy- related changes in peer-review outcomes for immediate/DOA and late deaths but not for early deaths. The proportion of overall agreement between pre- and postautopsy outcomes for the immediate/DOA category was 94.3% (50/53); three deaths initially deemed NP were reclassified as potentially preventable (PP) after autopsy. Overall agreement for the late category was 87% (20/23); one PP was reclassified as NP and two NPs were reclassified as PP.
Autopsy data enhanced peer review in immediate/DOA and late death after injury but did not impact peer review in early deaths. Autopsy data were most important to the analysis of late deaths. Targeting autopsy performance to these mortality categories is an effective strategy for centers with constrained access to autopsy data.
在成熟的创伤中心，尸检结果的价值在同行评审中受到质疑。我们试图确定尸检数据对同行评审过程的影响。
这是一项回顾性研究。分析的数据包括死亡类型（即刻死亡/到达时死亡[DOA]；早期[≤48小时]；晚期[>48小时]）、损伤严重度评分（ISS）、创伤和损伤严重度评分生成的生存概率（PS）、同行评审对可预防性的判断以及尸检结果。将死亡病例归类；然后比较尸检前后的ISS评分、PS以及同行评审过程的结果（不可预防百分比[%NP]）。进行配对t检验（α = 0.05）以确定ISS评分和PS的变化是否具有统计学意义。所有描述性和推断性分析均基于具有相关变量尸检前后数据的病例。
在170例死亡病例中，126例进行了尸检（74.1%），112份尸检报告可用（89.9%）。尸检数据导致每个死亡类别中ISS评分以及即刻/DOA和早期类别中PS发生统计学显著变化。对于即刻/DOA和晚期死亡，同行评审结果也有与尸检相关的变化，但早期死亡没有。即刻/DOA类别尸检前后结果的总体一致比例为94.3%（50/53）；3例最初被判定为不可预防（NP）的死亡在尸检后被重新分类为潜在可预防（PP）。晚期类别总体一致比例为87%（20/23）；1例PP被重新分类为NP，2例NP被重新分类为PP。
尸检数据增强了对损伤后即刻/DOA和晚期死亡的同行评审，但对早期死亡的同行评审没有影响。尸检数据对晚期死亡的分析最为重要。对于尸检数据获取受限的中心，针对这些死亡类别进行尸检是一种有效策略。
