Groven Sigrid, Eken Torsten, Skaga Nils Oddvar, Roise Olav, Naess Paal Aksel, Gaarder Christine
Department of Traumatology, Oslo University Hospital, Ulleval, Norway.
J Trauma. 2011 Mar;70(3):569-74. doi: 10.1097/TA.0b013e31820d1a9b.
Few studies have evaluated intrainstitutional improvement of trauma care. We hypothesized that the formalization of a dedicated multidisciplinary trauma service in a major Scandinavian trauma center in 2005 would result in improved outcome.
Institutional trauma registry data for 7,243 consecutive patients from the years 2002-2008 were retrospectively evaluated using variable life-adjusted display (VLAD) as one of several performance indicators. VLAD is a refinement of the cumulative sum method that adjusts death and survival by each patient's risk status (probability of survival) and provides a graphical display of performance over time. Probability of survival was calculated according to Trauma and Injury Severity Score (TRISS) methodology with National Trauma Data Bank 2005 coefficients.
VLAD demonstrated a sharp increase in cumulative survival starting at the beginning of 2005 and continuing linearly throughout the study period, amounting to 68 additional saved lives. The increase was mainly caused by improved survival among the critically injured (injury severity score 25-75). A cutoff point t0 for analysis of differences between time periods was set at January 1, 2005, coinciding with the formalization of a dedicated trauma service. Mortality in the whole trauma population showed a 33% decrease after t0. W-statistics confirmed the increased survival to be significant. There were no significant changes in age, gender, or injury mechanism. Injury severity score decreased, but differences in case mix were adjusted for in the survival prediction model.
We have shown that the start of the long-lasting performance improvement coincided with formalization of a dedicated trauma service, providing increased multidisciplinary focus on all aspects of trauma care.
很少有研究评估创伤护理在机构内部的改善情况。我们假设，2005年在斯堪的纳维亚半岛一家大型创伤中心设立专门的多学科创伤服务机构会带来更好的治疗效果。
回顾性评估了2002年至2008年期间连续7243例患者的机构创伤登记数据，使用可变寿命调整显示（VLAD）作为多项绩效指标之一。VLAD是累积和方法的改进，通过每位患者的风险状态（生存概率）调整死亡和生存情况，并以图形方式展示随时间的绩效。生存概率根据创伤和损伤严重程度评分（TRISS）方法及2005年国家创伤数据库系数进行计算。
VLAD显示，从2005年初开始累积生存率急剧上升，并在整个研究期间呈线性持续上升，额外挽救了68条生命。这一增长主要是由于重伤患者（损伤严重程度评分为25 - 75）的生存率提高。将分析不同时间段差异的分界点t0设定为2005年1月1日，这与专门创伤服务机构的设立时间一致。t0之后，整个创伤人群的死亡率下降了33%。W统计量证实生存率的提高具有显著性。年龄、性别或损伤机制没有显著变化。损伤严重程度评分有所下降，但在生存预测模型中对病例组合的差异进行了调整。
我们已经表明，长期的绩效改善始于专门创伤服务机构的设立，这使得多学科对创伤护理的各个方面给予了更多关注。
