Skaga Nils O, Eken Torsten, Jones J Mary, Steen Petter A
Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway.
Injury. 2008 May;39(5):612-22. doi: 10.1016/j.injury.2007.11.426.
Death during acute care hospitalisation is commonly used as a principal outcome indicator in injury research. This endpoint excludes post-hospital trauma-related deaths, which are substantial according to recent US studies. Two additional ways of defining outcome in trauma victims are also used; by end of somatic care, and at 30 days after injury. Our primary aim was to analyse how the different definitions of trauma outcome influence performance analyses. Secondly, we wanted to evaluate whether 30 days mortality after injury, which is widely used in other parts of biomedicine and recommended by the United Nations for use in transport statistics, is a suitable endpoint in trauma research.
We conducted a retrospective analysis of prospectively collected data from the hospital based trauma registry at Ulleval University Hospital (UUH) in Oslo, Norway. Outcome measure was mortality at discharge from UUH, i.e., by "end of acute care", at end of somatic care defined as discharge from final acute care hospital, and at 30 days after injury. Analyses were performed according to conventional TRISS methodology.
3332 of 3446 patients from the years 2000-2004 were included. Of these, 323 (9.7%) died within 30 days of injury or during somatic care more than 30 days after injury. Mortality varied with outcome definition, with 264 deaths (81.7% of total deaths) before discharge from UUH, 318 (98.4%) before end of somatic care, and 308 (95.4%) within 30 days after injury. TRISS-based trauma system performance evaluation for blunt trauma showed significantly better outcome than predicted with discharge from UUH as outcome definition, whereas for category 30 days after injury, performance was clearly less favourable. Performance for penetrating trauma was not affected, since all deaths occurred before 30 days, and nearly all before discharge from UUH.
A substantial number of in-hospital deaths following blunt trauma occurs after discharge from the primary institution, i.e., unnoticed when "end of acute care" is used as outcome definition. Consequently, outcome definition influenced performance when comparing our institution to an acknowledged standard. We recommend mortality occurring within 30 days of injury as endpoint in trauma research.
急性住院期间的死亡通常被用作创伤研究中的主要结局指标。该终点排除了院后创伤相关死亡，而根据美国最近的研究，此类死亡数量相当可观。在创伤受害者中还采用了另外两种定义结局的方式；即躯体护理结束时以及受伤后30天。我们的主要目的是分析创伤结局的不同定义如何影响性能分析。其次，我们想评估受伤后30天死亡率（这在生物医学的其他领域广泛使用且被联合国推荐用于交通统计）是否是创伤研究中的合适终点。
我们对挪威奥斯陆于勒瓦尔大学医院（UUH）前瞻性收集的基于医院创伤登记处的数据进行了回顾性分析。结局指标是UUH出院时的死亡率，即“急性护理结束时”、躯体护理结束时（定义为从最后一家急性护理医院出院）以及受伤后30天的死亡率。分析按照传统的TRISS方法进行。
纳入了2000 - 2004年的3446例患者中的3332例。其中，323例（9.7%）在受伤后30天内或受伤后30天以上的躯体护理期间死亡。死亡率随结局定义而变化，UUH出院前有264例死亡（占总死亡人数的81.7%），躯体护理结束前有318例（98.4%），受伤后30天内有308例（95.4%）。以TRISS为基础的钝性创伤创伤系统性能评估显示，与以UUH出院作为结局定义相比，结局明显好于预期，而对于受伤后30天这一类别，性能明显较差。穿透性创伤的性能未受影响，因为所有死亡均发生在30天之前，且几乎所有死亡都发生在UUH出院之前。
钝性创伤后的大量院内死亡发生在从主要机构出院之后，即当以“急性护理结束时”作为结局定义时未被注意到。因此，在将我们的机构与公认标准进行比较时，结局定义影响了性能。我们建议将受伤后30天内的死亡率作为创伤研究的终点。
