Pracht Etienne E, Tepas Joseph J, Langland-Orban Barbara, Simpson Lisa, Pieper Pam, Flint Lewis M
University of South Florida College of Public Health, Tampa, FL 33601, USA.
J Pediatr Surg. 2008 Jan;43(1):212-21. doi: 10.1016/j.jpedsurg.2007.09.047.
The purposes of the study were to compare the survival associated with treatment of seriously injured patients with pediatric trauma in Florida at designated trauma centers (DTCs) with nontrauma center (NCs) acute care hospitals and to evaluate differences in mortality between designated pediatric and nonpediatric trauma centers.
Trauma-related inpatient hospital discharge records from 1995 to 2004 were analyzed for children aged from 0 to 19 years. Age, sex, ethnicity, injury mechanism, discharge diagnoses, and severity as defined by the International Classification Injury Severity Score were analyzed, using mortality during hospitalization as the outcome measure. Children with central nervous system, spine, torso, and vascular injuries and burns were evaluated. Instrumental variable analysis was used to control for triage bias, and mortality was compared by probabilistic regression and bivariate probit modeling. Children treated at a DTC were compared with those treated at a nontrauma center. Within the population treated at a DTC, those treated at a DTC with pediatric capability were compared with those treated at a DTC without additional pediatric capability. Models were analyzed for children aged 0 to 19 years and 0 to 15 years.
For the 27,313 patients between ages 0 and 19 years, treatment in DTCs was associated with a 3.15% reduction in the probability of mortality (P < .0001, bivariate probit). The survival advantage for children aged 0 to 15 years was 1.6%, which is not statistically significant. Treatment of 16,607 children in a designated pediatric DTC, as opposed to a nonpediatric DTC, was associated with an additional 4.84% reduction in mortality in the 0- to 19-year age group and 4.5% in the 0 to 15 years group (P < .001, bivariate probit).
Optimal care of the seriously injured child requires both the extensive and immediate resources of a DTC as well as pediatric-specific specialty support.
本研究的目的是比较佛罗里达州指定创伤中心（DTC）与非创伤中心（NC）急性护理医院对严重受伤的儿科创伤患者进行治疗后的生存率，并评估指定儿科创伤中心与非儿科创伤中心之间的死亡率差异。
分析了1995年至2004年期间0至19岁儿童与创伤相关的住院出院记录。分析了年龄、性别、种族、损伤机制、出院诊断以及国际疾病分类损伤严重程度评分所定义的严重程度，以住院期间的死亡率作为结局指标。对患有中枢神经系统、脊柱、躯干、血管损伤和烧伤的儿童进行了评估。使用工具变量分析来控制分诊偏倚，并通过概率回归和双变量概率模型比较死亡率。将在DTC接受治疗的儿童与在非创伤中心接受治疗的儿童进行比较。在DTC接受治疗的人群中，将在具有儿科治疗能力的DTC接受治疗的儿童与在没有额外儿科治疗能力的DTC接受治疗的儿童进行比较。对0至19岁和0至15岁的儿童模型进行了分析。
对于27313名年龄在0至19岁之间的患者，在DTC接受治疗与死亡率降低3.15%相关（双变量概率模型，P <.0001）。0至15岁儿童的生存优势为1.6%，无统计学意义。与非儿科DTC相比，在指定的儿科DTC对16607名儿童进行治疗，在0至19岁年龄组中死亡率额外降低4.84%，在0至15岁年龄组中降低4.5%（双变量概率模型，P <.001）。
对严重受伤儿童的最佳护理既需要DTC广泛而即时的资源，也需要儿科专科支持。
