Bukur Marko, Singer Matthew B, Chung Rex, Ley Eric J, Malinoski Darren J, Margulies Daniel R, Salim Ali
Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, 8635WThird St, Ste 650, Los Angeles, CA 90048, USA.
Arch Surg. 2012 Sep;147(9):856-62. doi: 10.1001/archsurg.2012.1672.
Discrepancies exist in complications and outcomes at teaching trauma centers (TTCs) vs nonteaching TCs (NTCs).
Retrospective review of the National Trauma Data Bank research data sets (January 1, 2007, through December 31, 2008).
Level II TCs.
Patients at TTCs were compared with patients at NTCs using demographic, clinical, and outcome data. Regression modeling was used to adjust for confounding factors to determine the effect of house staff presence on failure to rescue, defined as mortality after an in-house complication.
The primary outcome measures were major complications, in-hospital mortality, and failure to rescue.
In total, 162 687 patients were available for analysis, 36 713 of whom (22.6%) were admitted to NTCs. Compared with patients admitted to TTCs, patients admitted to NTCs were older (52.8 vs 50.7 years), had more severe head injuries (8.3% vs 7.8%), and were more likely to undergo immediate operation (15.0% vs 13.2%) or ICU admission (28.1% vs 22.8%) (P < .01 for all). The mean Injury Severity Scores were similar between the groups (10.1 for patients admitted to NTCs vs 10.4 for patients admitted to TTCs, P < .01). Compared with patients admitted to TTCs, patients admitted to NTCs experienced fewer complications (adjusted odds ratio [aOR], 0.63; P < .01), had a lower adjusted mortality rate (aOR, 0.87; P = .01), and were less likely to experience failure to rescue (aOR, 0.81; P = .01).
Admission to level II TTCs is associated with an increased risk for major complications and a higher rate of failure to rescue compared with admission to level II NTCs. Further investigation of the differences in care provided by level II TTCs vs NTCs may identify areas for improvement in residency training and processes of care.
教学创伤中心（TTC）与非教学创伤中心（NTC）在并发症和治疗结果方面存在差异。
对国家创伤数据库研究数据集（2007年1月1日至2008年12月31日）进行回顾性分析。
二级创伤中心。
使用人口统计学、临床和治疗结果数据，将TTC的患者与NTC的患者进行比较。采用回归模型对混杂因素进行调整，以确定住院医生的存在对抢救失败（定义为院内并发症后的死亡率）的影响。
主要观察指标为严重并发症、院内死亡率和抢救失败。
共有162687例患者可供分析，其中36713例（22.6%）入住NTC。与入住TTC的患者相比，入住NTC的患者年龄更大（52.8岁对50.7岁），头部损伤更严重（8.3%对7.8%），更有可能接受急诊手术（15.0%对13.2%）或入住重症监护病房（28.1%对22.8%）（所有P值均<0.01）。两组的平均损伤严重程度评分相似（入住NTC的患者为10.1，入住TTC的患者为10.4，P<0.01）。与入住TTC的患者相比，入住NTC的患者并发症更少（调整优势比[aOR]，0.63；P<0.01），调整死亡率更低（aOR，0.87；P=0.01），抢救失败的可能性更小（aOR，0.81；P=0.01）。
与入住二级NTC相比，入住二级TTC发生严重并发症的风险增加，抢救失败率更高。对二级TTC与NTC所提供护理差异的进一步调查可能会发现住院医师培训和护理流程中有待改进的方面。
