Pracht Etienne E, Langland-Orban Barbara, Flint Lewis
Health Policy and Management, Tampa, FL, USA.
J Trauma. 2011 Jul;71(1):69-77. doi: 10.1097/TA.0b013e31820e82b7.
This article analyzes the effectiveness of designated trauma centers (DTCs) in Florida concerning reduction in the mortality risk of severely injured elderly trauma victims.
Inpatient hospital data collected by the Agency for Health Care Administration were used to identify elderly trauma patients. An instrumental variables method was used to adjust for prehospital selection bias in addition to the influence of age, gender, race, risk of mortality, comorbidities, and type of injury. The model was estimated using a bivariate probit full information maximum likelihood model to determine the impact of triage to a trauma center as opposed to a nontrauma hospital.
After adjusting for confounding influences, treatment at a DTC was associated with a statistically significant reduction of 0.072, 0.040, and 0.036 in the probability of mortality for patients in the age groups 65 years to 74 years, 75 years to 84 years, and ≥ 85 years, respectively.
Treatment of severely injured elderly trauma patients in DTCs is associated with statistically significant gains in the probability of survival.
本文分析了佛罗里达州指定创伤中心（DTCs）在降低老年严重创伤患者死亡风险方面的有效性。
利用医疗保健管理机构收集的住院患者数据来识别老年创伤患者。除了年龄、性别、种族、死亡风险、合并症和损伤类型的影响外，还使用工具变量法来调整院前选择偏倚。使用双变量概率全信息最大似然模型估计该模型，以确定分诊到创伤中心而非非创伤医院的影响。
在调整混杂影响后，65岁至74岁、75岁至84岁和≥85岁年龄组患者在DTC接受治疗的死亡概率分别显著降低0.072、0.040和0.036。
在DTC治疗老年严重创伤患者与生存概率的显著提高相关。
