基于人群的分类 III 级和 IV 级农村医院为创伤中心的生存评估。

A population-based survival assessment of categorizing level III and IV rural hospitals as trauma centers.

机构信息

Department of Sociology, Portland State University, Portland, OR, USA.

出版信息

J Rural Health. 2009 Spring;25(2):182-8. doi: 10.1111/j.1748-0361.2009.00215.x.

DOI:10.1111/j.1748-0361.2009.00215.x

PMID:19785584

Abstract

CONTEXT

Patients injured in rural areas are hypothesized to have improved outcomes if statewide trauma systems categorize rural hospitals as Level III and IV trauma centers, though evidence to support this belief is sparse.

PURPOSE

To determine if there is improved survival among injured patients hospitalized in states that categorize rural hospitals as trauma centers.

METHODS

We analyzed a retrospective cohort of injured patients included in the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 1997 to 1999. We used generalized estimating equations to compare survival among injured patients hospitalized in states that categorize rural hospitals as Level III and IV trauma centers versus those that do not. Multivariable models adjusted for important confounders, including patient demographics, co-morbid conditions, injury severity, and hospital-level factors.

FINDINGS

There were 257,044 admitted patients from 7 states with a primary injury diagnosis, of whom 64,190 (25%) had a "serious" index injury, 32,763 (13%) were seriously injured (by ICD-9 codes), and 12,435 (5%) were very seriously injured (by ICD-9 codes). There was no survival benefit associated with rural hospital categorization among all patients with a primary injury diagnosis or for those with specific index injuries. However, seriously injured patients (by ICD-9 codes) had improved survival when hospitalized in a categorizing state (OR for mortality 0.72, 95% confidence interval [CI] 0.53-0.97; OR for very seriously injured 0.68, 95% CI 0.52-0.90).

CONCLUSIONS

There was no survival benefit to categorizing rural hospitals among a broad, heterogeneous group of hospitalized patients with a primary injury diagnosis; however the most seriously injured patients did have increased survival in such states.

摘要

背景

假设全州范围内的创伤系统将农村医院分类为三级和四级创伤中心，那么在农村地区受伤的患者预后会得到改善，但支持这一观点的证据很少。

目的

确定将农村医院归类为创伤中心的州的受伤患者的生存率是否有所提高。

方法

我们分析了 1997 年至 1999 年期间纳入医疗保健成本和利用项目全国住院患者样本的受伤患者的回顾性队列。我们使用广义估计方程来比较在将农村医院归类为三级和四级创伤中心的州住院的受伤患者的生存率与不在这些州住院的患者的生存率。多变量模型调整了重要的混杂因素，包括患者人口统计学特征、合并症、伤害严重程度和医院水平因素。

发现

在有主要损伤诊断的 7 个州中，有 257044 名入院患者，其中 64190 名（25%）有“严重”的主要损伤，32763 名（13%）严重受伤（根据 ICD-9 代码），12435 名（5%）非常严重受伤（根据 ICD-9 代码）。在所有有主要损伤诊断的患者中，或者在有特定主要损伤的患者中，农村医院分类与生存率之间没有关联。然而，严重受伤的患者（根据 ICD-9 代码）在分类州住院时生存率有所提高（死亡率的优势比为 0.72，95%置信区间为 0.53-0.97；非常严重受伤的优势比为 0.68，95%置信区间为 0.52-0.90）。