包容性创伤系统是否能改善肾损伤后的结局？

Do inclusive trauma systems improve outcomes after renal trauma?

机构信息

Department of Urology, University of Washington School of Medicine, Harborview Injury Prevention and Research Center, 325 9th Avenue, Seattle, WA 98104, USA.

出版信息

J Trauma Acute Care Surg. 2012 Feb;72(2):385-9. doi: 10.1097/TA.0b013e3182411c67.

DOI:10.1097/TA.0b013e3182411c67

PMID:22327981

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3281515/

Abstract

BACKGROUND

Our aim is to assess state variation in renal trauma outcomes. We hypothesize that states with more hospitals participating in a trauma system will have lower nephrectomy and mortality rates.

METHODS

The Healthcare Cost and Utilization Project State Inpatient Database was used to conduct a retrospective cohort study of all patients hospitalized with renal injury from partnering states during 2001, 2004, and 2007. State trauma systems were categorized based on the proportion of all acute care hospitals designated as a trauma center (Levels I-V) with higher proportions correlating to a more inclusive system. Poisson regression for relative risks (RRs) of inpatient nephrectomy and case fatality were performed adjusting for patient and state level factors.

RESULTS

Patients in states with the "most inclusive" trauma systems had a 30% lower risk of nephrectomy (RR, 0.70; 95% confidence interval [CI], 0.56-0.88) and a 2.06% lower unadjusted inpatient case fatality rate compared with states with "exclusive" trauma systems. Inpatient case fatality risk varied significantly by trauma system inclusiveness. Patients treated in states with either a "more inclusive" (RR, 0.85; 95% CI, 0.74-0.97) or "most inclusive" (RR, 0.74; 95% CI, 0.64-0.85) trauma system were independently associated with a lower inpatient case fatality risk compared with states with "exclusive" systems.

CONCLUSIONS

A reduced risk of nephrectomy and inpatient case fatality are more common among states that have a higher proportion of acute care hospitals participating as a trauma center (Levels I-V). Standardization of care may correlate with improved patient outcomes after renal trauma.

LEVEL OF EVIDENCE

II, exploratory cohort analysis.

摘要

背景

我们的目的是评估肾外伤结局的州际差异。我们假设参与创伤系统的医院数量较多的州，肾切除术和死亡率会更低。

方法

利用医疗保健成本和利用项目州际住院患者数据库，对 2001 年、2004 年和 2007 年期间合作州所有因肾损伤住院的患者进行回顾性队列研究。根据被指定为创伤中心（I-V 级）的所有急性护理医院的比例对州创伤系统进行分类，比例越高表示系统越全面。对患者和州级别的因素进行调整后，采用泊松回归分析比较住院肾切除术和病例死亡率的相对风险（RR）。

结果

在“最全面”的创伤系统中，患者肾切除术的风险降低了 30%（RR，0.70；95%置信区间[CI]，0.56-0.88），未经调整的住院病死率降低了 2.06%。创伤系统的包容性不同，住院病死率的风险也有显著差异。与“排他性”创伤系统相比，在“更全面”（RR，0.85；95%CI，0.74-0.97）或“最全面”（RR，0.74；95%CI，0.64-0.85）创伤系统治疗的患者，住院病死率风险独立降低。