Diggs Brian S, Mullins Richard J, Hedges Jerris R, Arthur Melanie, Newgard Craig D
Department of Surgery, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
J Am Coll Surg. 2008 Feb;206(2):212-9. doi: 10.1016/j.jamcollsurg.2007.08.019. Epub 2007 Nov 26.
Multiple regional trauma systems have been implemented over the past 3 decades to achieve the goal of regionalized care for injured patients. The American College of Surgeons Committee on Trauma (ACS-COT) advocates that seriously injured patients should be treated in designated Level I trauma centers that meet criteria including admitting more than 1,200 injured patients annually. Reliable measures are needed to evaluate the implementation of regionalized care nationally. The goal of this study was to measure the proportion of seriously injured patients treated at high injury-volume hospitals.
We performed a retrospective observational study of injured patients hospitalized in the US during the years 1995 to 2003, drawn from the Nationwide Inpatient Sample. Hospitals were ranked in order of annual volume of injured patient admissions. A patient's severity of injury was calculated using ICD-9-based Injury Severity Score (ICISS). The principal measure was the proportion of seriously injured patients (ICISS<or=0.90) admitted to high-volume hospitals.
Nine hundred fifteeen injured patients admitted per year is the empiric threshold for hospitals with a high injury volume. Only 7% of hospitals in the US meet this volume threshold. Sixty percent of seriously injured patients are treated in these high-volume hospitals; within the elder (age 65 years or older) subset, this percentage is lower.
The proportion of seriously injured patients in high-volume hospitals is a functional metric that provides a practicable and comprehensive measure of regionalized trauma care in the US. Injured elder Americans have less access to experienced trauma hospitals.
在过去三十年中，多个区域创伤系统已被实施，以实现对受伤患者进行区域化护理的目标。美国外科医师学会创伤委员会（ACS - COT）主张，重伤患者应在符合标准的指定一级创伤中心接受治疗，这些标准包括每年收治超过1200名受伤患者。需要可靠的措施来评估全国范围内区域化护理的实施情况。本研究的目的是测量在高受伤量医院接受治疗的重伤患者的比例。
我们对1995年至2003年期间在美国住院的受伤患者进行了一项回顾性观察研究，数据来自全国住院患者样本。医院按照每年收治受伤患者的数量进行排名。使用基于ICD - 9的损伤严重度评分（ICISS）计算患者的损伤严重程度。主要指标是入住高收治量医院的重伤患者（ICISS≤0.90）的比例。
每年收治915名受伤患者是高受伤量医院的经验阈值。美国只有7%的医院达到这个收治量阈值。60%的重伤患者在这些高收治量医院接受治疗；在老年（65岁及以上）亚组中，这一比例较低。
高收治量医院中重伤患者的比例是一个功能性指标，它为美国区域化创伤护理提供了一种可行且全面的衡量方法。受伤的美国老年人获得经验丰富的创伤医院治疗的机会较少。
