Schroeppel Thomas J, Fischer Peter E, Magnotti Louis J, Croce Martin A, Fabian Timothy C
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
J Am Coll Surg. 2009 Sep;209(3):378-84. doi: 10.1016/j.jamcollsurg.2009.05.026. Epub 2009 Jul 24.
The concept of increased medical errors in July, secondary to new residents (the "July phenomenon"), often receives considerable attention without supporting evidence. A recent study reported a 41% increase in mortality during July and August in general surgery patients. The objective of this study was to determine if a July phenomenon existed in a Level I trauma center with an attending present at all times.
A retrospective cohort study was conducted at an academic, tertiary Level I trauma center. Blunt trauma patients admitted during a 5-year period were compared for differences in outcomes by month and quarter. Chi-square and analysis of variance were used for categorical and continuous variables where appropriate. Linear regression was used to examine the effect of month on ventilator support days, ICU days, and minutes in the resuscitation room. Multivariable linear regression was used to examine the effect of month and quarter on mortality.
A total of 12,525 patients were analyzed by month and 14,798 patients were analyzed by quarter. Overall, 68% were men and 32% women, with a mean age of 39.5 years. Mean Injury Severity Score was 12.4. Mean 24-hour transfusion requirement was 0.5 U. Mean emergency department Glasgow Coma Scale score was 14. Multivariable logistic regression failed to show month or quarter of the year to be an independent predictor of mortality after adjusting for age, Injury Severity Score, emergency department Glasgow Coma Scale score, and 24-hour transfusion requirement (c = 0.97). Linear regression failed to show any monthly variation on ventilator-support days, ICU days, or minutes in the resuscitation room.
The July phenomenon does not exist at this Level I trauma center with in-hospital attending supervision.
继发于新住院医师的7月医疗差错增加的概念（“7月现象”），常常在没有支持证据的情况下受到相当多的关注。最近一项研究报告称，普通外科患者在7月和8月的死亡率增加了41%。本研究的目的是确定在一个始终有主治医生在场的一级创伤中心是否存在7月现象。
在一家学术性三级一级创伤中心进行了一项回顾性队列研究。对5年期间收治的钝性创伤患者按月份和季度比较结局差异。在适当情况下，对分类变量和连续变量分别使用卡方检验和方差分析。使用线性回归来检验月份对呼吸机支持天数、重症监护病房（ICU）天数和复苏室停留分钟数的影响。使用多变量线性回归来检验月份和季度对死亡率的影响。
按月份分析了总共12525例患者，按季度分析了14798例患者。总体而言，68%为男性，32%为女性，平均年龄为39.5岁。平均损伤严重度评分（Injury Severity Score）为12.4。平均24小时输血量需求为0.5单位。急诊科格拉斯哥昏迷量表（Glasgow Coma Scale）平均评分为14分。在对年龄、损伤严重度评分、急诊科格拉斯哥昏迷量表评分和24小时输血量需求进行校正后，多变量逻辑回归未能显示一年中的月份或季度是死亡率的独立预测因素（c = 0.97）。线性回归未能显示在呼吸机支持天数、ICU天数或复苏室停留分钟数上存在任何月度变化。
在这家有院内主治医生监督的一级创伤中心不存在7月现象。
