Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
J Trauma Acute Care Surg. 2013 Jul;75(1):60-8; discussion 68. doi: 10.1097/TA.0b013e31829880a0.
Injuries remain a leading cause of death in the developing world. Whereas new investments are welcome, quality improvement (QI) at the currently available trauma care facilities is essential. The objective of this study was to determine the effect and long-term sustainability of trauma QI initiatives on in-hospital mortality and complications at a large tertiary hospital in a developing country.
In 2002, a specialized trauma team was formed (members trained using advanced trauma life support), and a western style trauma program established including a registry and quality assurance program. Patients from 1998 onward were entered in to this registry, enabling a preimplementation and postimplementation study. Adults (>15 years) with blunt or penetrating trauma were analyzed. The main outcomes of interest were (1) in-hospital mortality and (2) occurrence of any complication. Multiple logistic regression was performed to assess the impact of formalized trauma care on outcomes, controlling for covariates reaching significance in the bivariate analyses.
A total of 1,227 patient records were analyzed. Patient demographics and injury characteristics are described in Table 1. Overall in-hospital mortality rate was 6.4%, and the complication rate was 11.1%. On multivariate analysis, patients admitted during the trauma service years were 4.9 times less likely to die (95% confidence interval, 1.77-13.57) and 2.60 times (odds ratio; 95% confidence interval, 1.29-5.21) less likely to have a complication compared with those treated in the pretrauma service years.
Despite significant delays in hospital transit and lack of prehospital trauma care, hospital level implementation of trauma QI program greatly decreases mortality and complication rates in the developing world.
Care management study, level IV.
在发展中国家，创伤仍然是导致死亡的主要原因。虽然新的投资受到欢迎，但提高目前创伤救治设施的质量至关重要。本研究旨在确定在发展中国家的一家大型三级医院实施创伤质量改进（QI）措施对院内死亡率和并发症的影响及其长期可持续性。
2002 年，成立了一个专门的创伤小组（使用高级创伤生命支持培训成员），并建立了一个西式创伤项目，包括一个登记处和质量保证计划。1998 年以后的患者被纳入该登记处，从而可以进行实施前和实施后的研究。分析了钝性或穿透性创伤的成年患者（>15 岁）。主要研究结果为（1）院内死亡率和（2）任何并发症的发生。使用多元逻辑回归来评估规范化创伤救治对结局的影响，控制在双变量分析中达到显著性的协变量。
共分析了 1227 例患者的记录。表 1 描述了患者的人口统计学和损伤特征。总体院内死亡率为 6.4%，并发症发生率为 11.1%。多变量分析显示，在创伤服务年限内入院的患者死亡的可能性降低 4.9 倍（95%置信区间，1.77-13.57），发生并发症的可能性降低 2.60 倍（比值比；95%置信区间，1.29-5.21），与创伤服务年限前治疗的患者相比。
尽管在医院转运过程中存在显著延迟，且缺乏院前创伤救治，但在发展中国家实施医院层面的创伤 QI 项目可大大降低死亡率和并发症发生率。
护理管理研究，IV 级。
