Ziran Bruce H, Barrette-Grischow Mary-Kate, Hileman Barbara
Orthopaedic Trauma, St. Elizabeth Health Center, Youngstown, USA.
Orthopaedic Trauma Research, St. Elizabeth Health Center, Youngstown, USA.
Patient Saf Surg. 2008 Jul 21;2:18. doi: 10.1186/1754-9493-2-18.
The American College of Surgeons delineates 108 requirements for level I trauma centers. Some of these requirements include: minimum of 1,200 trauma admissions per year; an average of 35 major trauma patients per surgeon; residency training programs; and 10 peer-reviewed journal submissions every three years. This study examines the variation in services provided among U.S. level I trauma centers.
218 facilities identified as level I trauma centers in 2005 were contacted for participation. 136 centers in 37 states completed the questionnaire. Surveys queried variances in trauma, neurosurgery, plastics, and orthopaedic surgery with regard to type of center, type of accreditation, number and training of participating physicians, number of beds, dedicated OR support (staff/rooms), call pay, and research.
Of the level I centers surveyed, 66% are university-affiliated facilities that employ more surgeons and staffing across trauma and all subspecialties compared to community-based or public centers. However, the community and public centers have more surgeons per capita (44% of the university-affiliated hospitals have six or more trauma surgeons on staff compared to 59% of the community and 70% of the public facilities). University-affiliated centers also provide more in-house subspecialty services (orthopaedic, neurosurgery, and plastics). Thirty-nine percent do not have ACS accreditation and are designated trauma facilities by state or local governments. Only 49% of trauma centers provide on-call pay to trauma surgeons, and these percentages decline for all subspecialties. Dedicated operating rooms and research programs are also lacking among all subspecialties.
Based on our findings, we conclude that there are no homogeneous criteria for being accredited as a level I trauma center. Reliable resources should be offered at any facility that claims a level I trauma designation. We do not know if such diversity of services truly impacts care or how it can be measured; nevertheless, it would be logical to presume that at some point services that fall below a minimum threshold would potentially adversely affect the quality of care. In order to develop appropriate policy to decrease possible disparities, differentiation in services between trauma centers must be further researched and described.
美国外科医师学会规定了一级创伤中心的108项要求。其中一些要求包括：每年至少收治1200名创伤患者；每位外科医生平均负责35名严重创伤患者；住院医师培训项目；以及每三年提交10篇经同行评审的期刊论文。本研究调查了美国一级创伤中心提供服务的差异。
联系了2005年被确定为一级创伤中心的218家机构参与研究。37个州的136家中心完成了问卷调查。调查询问了创伤、神经外科、整形和骨科手术在中心类型、认证类型、参与医师数量和培训、床位数量、专用手术室支持（人员/房间）、值班薪酬和研究方面的差异。
在接受调查的一级中心中，66%是大学附属机构，与社区或公立中心相比，这些机构在创伤及所有亚专业领域雇佣了更多的外科医生和工作人员。然而，社区和公立中心的人均外科医生数量更多（44%的大学附属医院有6名或更多创伤外科医生在职，而社区医院为59%，公立机构为70%）。大学附属中心还提供更多的内部亚专业服务（骨科、神经外科和整形）。39%的中心没有美国外科医师学会的认证，而是由州或地方政府指定为创伤机构。只有49%的创伤中心为创伤外科医生提供值班薪酬，所有亚专业的这一比例都有所下降。所有亚专业领域也都缺乏专用手术室和研究项目。
根据我们的研究结果，我们得出结论，被认证为一级创伤中心没有统一的标准。任何声称具有一级创伤指定的机构都应提供可靠的资源。我们不知道这种服务的多样性是否真的会影响医疗护理，也不知道如何衡量；然而，可以合理推测，在某些时候，低于最低门槛的服务可能会对医疗质量产生不利影响。为了制定适当的政策以减少可能的差异，必须进一步研究和描述创伤中心之间服务的差异。
