Salim Ali, Berry Cherisse, Ley Eric J, Schulman Danielle, Bukur Marko, Margulies Daniel R, Navarro Sonia, Malinoski Darren
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Am Surg. 2012 May;78(5):535-9.
We sought to investigate the effect of trauma center designation on organ donor outcomes during a 5-year period. A retrospective study of the southern California regional Organ Procurement Organization database comparing trauma centers (n = 25) versus nontrauma centers (n = 171) and Level I (n = 7) versus Level II (n = 18) trauma centers between 2004 and 2008 was performed. A total of 16,830 referrals were evaluated and 44 per cent were from trauma centers. When compared with nontrauma centers (n = 171), trauma centers (n = 25) had a higher percentage of medically suitable eligible deaths (29 vs 16%, P < 0.001), total eligible deaths (22 vs 12%, P < 0.001), and eligible donors (14 vs 7%, P < 0.001). Trauma Centers had a significantly higher number of organs procured per donor (4.0 ± 1.6 vs 3.5 ± 1.6, P < 0.001), organs transplanted per donor (OTPD) (3.6 ± 1.8 vs 2.8 ± 1.8, P < 0.001), and higher organ yield (per cent 4 or greater OTPD [48 vs 31%, P < 0.001]). No significant differences were found between Level I and Level II trauma centers. Trauma centers demonstrate significantly better organ donor outcomes compared with nontrauma centers. Factors responsible for improved outcomes at trauma centers should be evaluated, reproduced, and disseminated to nontrauma centers to alleviate the growing organ shortage crisis.
我们试图调查创伤中心指定在5年期间对器官捐献者结局的影响。对南加州地区器官获取组织数据库进行了一项回顾性研究，比较了2004年至2008年期间的创伤中心（n = 25）与非创伤中心（n = 171）以及Ⅰ级创伤中心（n = 7）与Ⅱ级创伤中心（n = 18）。共评估了16,830例转诊病例，其中44%来自创伤中心。与非创伤中心（n = 171）相比，创伤中心（n = 25）在医学上适合的合格死亡比例更高（29%对16%，P < 0.001），总合格死亡比例更高（22%对12%，P < 0.001），合格捐献者比例更高（14%对7%，P < 0.001）。创伤中心每位捐献者获取的器官数量显著更多（4.0 ± 1.6对3.5 ± 1.6，P < 0.001），每位捐献者移植的器官数量（OTPD）更多（3.6 ± 1.8对2.8 ± 1.8，P < 0.001），器官产出率更高（OTPD为4个或更多的百分比[48%对31%，P < 0.001]）。Ⅰ级和Ⅱ级创伤中心之间未发现显著差异。与非创伤中心相比，创伤中心的器官捐献者结局显著更好。应评估、重现并向非创伤中心传播导致创伤中心结局改善的因素，以缓解日益严重的器官短缺危机。
