Rivara Frederick P, Koepsell Thomas D, Wang Jin, Nathens Avery, Jurkovich Gregory A, Mackenzie Ellen J
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.
J Trauma. 2008 Jun;64(6):1594-9. doi: 10.1097/TA.0b013e3181493099.
: Trauma center physicians need to know the patient's prognosis to make appropriate clinical decisions when they take over the care of a transferred patient. We sought to compare the survival of injured patients after transfer to a trauma center with survival from a comparable time after injury among patients who had been admitted to the trauma center directly from the scene of injury.
: Study included 2,867 patients 18 years to 84 years of age with at least one Abbreviated Injury Scale score >/=3 injury transferred to a trauma center and 7,570 patients admitted directly to a trauma center. The outcome was death within one year after injury. Cox proportional hazards model for death was used accounting for time since injury, adjusted for age group, gender, injury severity, injury mechanism, and comorbidities.
: Overall, there was almost no increase in the adjusted risk of death for transfer patients in the year after injury [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.78, 1.27]. The adjusted risk of death was higher in transfer patients than nontransfer patients between 50 days and 365 days after injury (HR 1.28, 95% CI 0.79, 2.07), but not within the first 50 days (HR 0.95, 95% CI 0.76, 1.18). However these modest differences in survival within each period were not statistically significant.
: After accounting for key demographic and clinical characteristics, transfer status does not appear to be a significant independent predictor of survival among patients with moderate to severe injuries treated at Level I trauma centers.
创伤中心的医生在接手转诊患者的治疗时，需要了解患者的预后情况，以便做出恰当的临床决策。我们试图比较转诊至创伤中心的受伤患者的生存率与直接从受伤现场入院至创伤中心的患者在受伤后相当时间内的生存率。
研究纳入了2867例年龄在18岁至84岁之间、至少有一项简略损伤量表评分≥3分损伤的转诊至创伤中心的患者，以及7570例直接入院至创伤中心的患者。结局指标为受伤后一年内死亡。采用Cox比例风险模型计算死亡风险，对受伤时间、年龄组、性别、损伤严重程度、损伤机制和合并症进行校正。
总体而言，受伤后一年内转诊患者校正后的死亡风险几乎没有增加[风险比（HR）0.99，95%置信区间（CI）0.78，1.27]。受伤后50天至365天内，转诊患者校正后的死亡风险高于非转诊患者（HR 1.28，95%CI 0.79，2.07），但在最初50天内并非如此（HR 0.95，95%CI 0.76，1.18）。然而，各时间段内这些生存率的适度差异无统计学意义。
在考虑关键人口统计学和临床特征后，转诊状态似乎并非一级创伤中心治疗的中重度损伤患者生存的重要独立预测因素。
