Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY 14642, USA.
J Am Coll Surg. 2012 Sep;215(3):372-8. doi: 10.1016/j.jamcollsurg.2012.03.018. Epub 2012 May 24.
Within organized trauma systems, both Level I and Level II trauma centers are expected to have the resources to treat patients with major multisystem trauma. The evidence supporting separate designations for Level I and Level II trauma centers is inconclusive. The objective of this study was to compare mortality and complications for injured patients admitted to Level I and Level II trauma centers.
Using data from the Pennsylvania Trauma Outcomes Study registry, we performed a retrospective observational study of 208,866 patients admitted to 28 Level I and Level II trauma centers between 2000 and 2009. Regression modeling was used to estimate the association between patient outcomes and trauma center designation, after controlling for injury severity, mechanism of injury, transfer status, and physiology.
Patients admitted to Level I trauma centers had a 15% lower odds of mortality (adjusted odds ratio [adj OR] 0.85; 95% CI 0.72 to 0.99) and a 35% increased odds of complications (adj OR 1.37; 95% CI 1.04 to 1.79). The survival benefit associated with admission to Level I centers was strongest in patients with very severe injuries (Injury Severity Score [ISS] ≥ 25; adj OR 0.78; 95% CI 0.64 to 0.95). Less severely injured patients with an ISS < 9 (adj OR 0.91; 95% CI 0.64 to 1.30) and with an ISS between 9 and 15 (adj OR 0.98; 95% CI 0.81 to 1.18) had similar risks of mortality in Level I and Level II trauma centers.
Severely injured patients admitted to Level I trauma centers have a lower risk of mortality compared with patients admitted to Level II centers. These findings support the continuation of a 2-tiered designation system for trauma.
在有组织的创伤系统中，一级和二级创伤中心都应具备治疗多发创伤患者的资源。支持一级和二级创伤中心分别指定的证据尚无定论。本研究的目的是比较一级和二级创伤中心收治的创伤患者的死亡率和并发症。
利用宾夕法尼亚创伤结局研究登记处的数据，我们对 2000 年至 2009 年间 28 家一级和二级创伤中心收治的 208866 名患者进行了回顾性观察性研究。在控制损伤严重程度、损伤机制、转运状态和生理学后，采用回归模型来估计患者结局与创伤中心指定之间的关系。
收治于一级创伤中心的患者死亡率降低 15%（校正比值比 [adj OR] 0.85；95%可信区间 [CI] 0.72 至 0.99），并发症发生率增加 35%（adj OR 1.37；95% CI 1.04 至 1.79）。在损伤严重程度评分（ISS）≥25 的患者中，一级中心入院的生存获益最强（adj OR 0.78；95% CI 0.64 至 0.95）。ISS＜9 的轻度受伤患者（adj OR 0.91；95% CI 0.64 至 1.30）和 ISS 在 9 至 15 之间的中度受伤患者（adj OR 0.98；95% CI 0.81 至 1.18）在一级和二级创伤中心的死亡率风险相似。
与二级创伤中心收治的患者相比，收治于一级创伤中心的严重受伤患者死亡率较低。这些发现支持继续采用两级创伤指定系统。
