Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l'Enfant-Jésus), Université Laval, Quebec City, Quebec, Canada.
J Am Coll Surg. 2011 Sep;213(3):402-9. doi: 10.1016/j.jamcollsurg.2011.05.007. Epub 2011 Jun 16.
Trauma center performance evaluations generally include adjustment for injury severity, age, and comorbidity. However, disparities across trauma centers may be due to other differences in source populations that are not accounted for, such as socioeconomic status (SES). We aimed to evaluate whether SES influences trauma center performance evaluations in an inclusive trauma system with universal access to health care.
The study was based on data collected between 1999 and 2006 in a Canadian trauma system. Patient SES was quantified using an ecologic index of social and material deprivation. Performance evaluations were based on mortality adjusted using the Trauma Risk Adjustment Model. Agreement between performance results with and without additional adjustment for SES was evaluated with correlation coefficients.
The study sample comprised a total of 71,784 patients from 48 trauma centers, including 3,828 deaths within 30 days (4.5%) and 5,549 deaths within 6 months (7.7%). The proportion of patients in the highest quintile of social and material deprivation varied from 3% to 43% and from 11% to 90% across hospitals, respectively. The correlation between performance results with or without adjustment for SES was almost perfect (r = 0.997; 95% CI 0.995-0.998) and the same hospital outliers were identified.
We observed an important variation in SES across trauma centers but no change in risk-adjusted mortality estimates when SES was added to adjustment models. Results suggest that after adjustment for injury severity, age, comorbidity, and transfer status, disparities in SES across trauma center source populations do not influence trauma center performance evaluations in a system offering universal health coverage.
创伤中心的绩效评估通常包括对损伤严重程度、年龄和合并症的调整。然而，创伤中心之间的差异可能是由于其他未被考虑到的来源人群差异造成的，例如社会经济地位（SES）。我们旨在评估在具有普遍获得医疗保健的包容性创伤系统中，SES 是否会影响创伤中心的绩效评估。
该研究基于 1999 年至 2006 年在加拿大创伤系统中收集的数据。使用社会和物质剥夺的生态指数来量化患者 SES。使用创伤风险调整模型调整死亡率来进行绩效评估。通过相关系数评估在不额外调整 SES 的情况下进行绩效评估的结果之间的一致性。
研究样本包括来自 48 个创伤中心的总共 71784 名患者，其中 30 天内有 3828 例死亡（4.5%），6 个月内有 5549 例死亡（7.7%）。社会和物质剥夺的最高五分位数患者比例在医院之间从 3%到 43%不等，从 11%到 90%不等。有或没有 SES 调整的绩效结果之间的相关性几乎是完美的（r = 0.997；95%CI 0.995-0.998），并且确定了相同的医院异常值。
我们观察到 SES 在创伤中心之间存在重要差异，但在将 SES 添加到调整模型后，风险调整后的死亡率估计值没有变化。结果表明，在调整损伤严重程度、年龄、合并症和转移状态后，SES 在创伤中心来源人群中的差异不会影响提供全民医疗保险的系统中创伤中心的绩效评估。
