Masella Cesar Augusto, Pinho Vitor Ferreira, Costa Passos Afonso Dinis, Spencer Netto Fernando A C, Rizoli Sandro, Scarpelini Sandro
Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
J Trauma. 2008 Sep;65(3):653-8. doi: 10.1097/TA.0b013e3181802077.
Examination of the epidemiology and timing of trauma deaths has been deemed a useful method to evaluate the quality of trauma care.
The purpose of this study was to evaluate the quality of trauma care in a regional trauma system and in a university hospital in Brazil by comparing the timing of deaths in the studied prehospital and in-hospital settings to those published for trauma systems in other areas.
We analyzed the National Health Minister's System of Deaths Information for the prehospital mortality and we retrospectively collected the demographics, timelines, and trauma severity scores of all in-hospital patients who died after admission through the Emergency Unit of Hospital das Clinicas de Ribeirao Preto between 2000 and 2001.
During the study period, there were 787 trauma fatalities in the city: 448 (56.9%) died in the prehospital setting and 339 (43.1%) died after being admitted to a medical facility. In 2 years, 238 trauma deaths occurred in the studied hospital, and we found a complete clinical set of data for 224 of these patients. The majority of deaths in the prehospital setting were caused by penetrating injuries (66.7%), whereas in-hospital mortality was mainly because of blunt traumas (59.1%). The largest number of in-hospital deaths occurred beyond 72 hours of stay (107 patients-47%).
The region studied showed some deficiencies in prehospital and in-hospitals settings, in particular in the critical care and short-term follow-up of trauma patients when compared with the literature. Particularly, the late mortality may be related to training and human resources deficiency. Based on the timeline of trauma deaths, we can suggest that the studied region needs improvements in the prehospital trauma system and in hospital critical care.
对创伤死亡的流行病学和时间进行研究被认为是评估创伤护理质量的一种有用方法。
本研究的目的是通过比较所研究的院前和院内环境中的死亡时间与其他地区创伤系统公布的死亡时间，来评估巴西一个地区创伤系统和一家大学医院的创伤护理质量。
我们分析了国家卫生部长的死亡信息系统以获取院前死亡率，并回顾性收集了2000年至2001年间通过里贝朗普雷图临床医院急诊科入院后死亡的所有住院患者的人口统计学、时间线和创伤严重程度评分。
在研究期间，该市有787例创伤死亡：448例（56.9%）死于院前环境，339例（43.1%）在入院后死亡。在两年时间里，所研究的医院发生了238例创伤死亡，我们为其中224例患者找到了完整的临床数据集。院前环境中的大多数死亡是由穿透性损伤引起的（66.7%），而院内死亡率主要是由于钝性创伤（59.1%）。院内死亡人数最多的发生在住院72小时之后（107例患者 - 47%）。
与文献相比，所研究的地区在院前和院内环境中存在一些不足，特别是在创伤患者重症监护和短期随访方面。特别是，晚期死亡率可能与培训和人力资源不足有关。根据创伤死亡的时间线，我们可以认为所研究的地区需要改善院前创伤系统和医院重症监护。
