Trauma Team Dip. DEA-EAS, Ospedale Niguarda Ca'Granda, Piazza Ospedale Maggiore 3, Milan, 20162, Italy.
Universita' di Milano, Dip, Scienze cliniche Luigi Sacco, Milan, Italy.
World J Emerg Surg. 2013 Aug 12;8:32. doi: 10.1186/1749-7922-8-32. eCollection 2013.
Injury is a public health problem in terms of mortality, morbidity and disability. The implementation of a regionalised trauma system has been proved to significantly reduce the social impact of severe trauma on population. A population-based registry may be useful to obtain reliable epidemiologic data.
To perform an exhaustive analysis of severe trauma patients hospitalised in Lombardia, a region of northern Italy.
The regional Hospital Discharge Registry (HDR) was used to retrieve data of all patients who suffered from serious injuries from 2008 to 2010. ICD9-CM codes of discharge diagnoses were analysed and patients coded from 800.0 to 939.9 or from 950.0 to 959.9 have been retrieved. Femur fractures in elderly and patients with length of hospital stay less than 2 days were excluded. Patients have been considered seriously injured if discharged dead or any of followings: admission or transit in ICU, need of mechanical ventilation, tracheotomy, invasive hemodynamic monitoring. Average reimbursement based on DRG has been evaluated.
Student's t test, ANOVA for continuous data, chi-square test for categorical data were used, and a p value less than 0.05 was considered significant.
The severely injured patients hospitalised in Lombardia in three years were 11704, 391 per million per year. Overall mortality was 24.17% and increased with age. Males aging from 18 to 64 years had more occupational injuries, trauma on the road and violence by others. Females were more susceptible to domestic injuries and self inflicted violence, mostly in older ages. Acute mortality was higher after traffic accidents, while late mortality was increased in domestic trauma. Pediatric cases were unusual. A significant increase (+10.18%) in domestic trauma, with a concomitant decrease (-17.76%) in road-related accidents was observed in the three years study period. Reimbursement paid to hospitals for seriously injured was insufficient with regard to estimated costs of care.
Serious injury requiring hospitalisation in Lombardia is still an healthcare problem, with a trend toward a decrease of traffic accidents, increase in domestic trauma and involvement of older people. These results may help to plan a new regionalised Trauma System.
从死亡率、发病率和失能率方面来看，损伤是一个公共卫生问题。实施区域性创伤系统已被证明可显著降低严重创伤对人群的社会影响。基于人群的登记处可能有助于获得可靠的流行病学数据。
对意大利北部伦巴第大区住院的严重创伤患者进行全面分析。
利用区域医院出院登记处（HDR）检索 2008 年至 2010 年期间所有因严重损伤住院的患者数据。分析出院诊断的 ICD9-CM 编码，检索编码为 800.0 至 939.9 或 950.0 至 959.9 的患者。排除老年股骨骨折患者和住院时间少于 2 天的患者。如果出院时死亡或以下任何一种情况，则认为患者受重伤：入住或转至 ICU、需要机械通气、气管切开术、有创血流动力学监测。根据 DRG 评估平均报销金额。
使用学生 t 检验、连续数据的方差分析、分类数据的卡方检验，p 值<0.05 认为差异有统计学意义。
三年间，伦巴第大区住院的严重创伤患者为 11704 例，每年每百万人中有 391 例。总体死亡率为 24.17%，并随年龄增长而增加。18 至 64 岁的男性更易发生职业性损伤、道路伤和他人暴力伤。女性更易发生家庭伤和自我伤害，主要发生在年龄较大时。交通事故后急性死亡率较高，而家庭创伤后晚期死亡率增加。儿科病例罕见。在研究期间的三年中，观察到家庭创伤显著增加（+10.18%），而道路相关事故相应减少（-17.76%）。严重创伤患者住院治疗向医院支付的报销金与护理费用估计值相比不足。
在伦巴第大区，需要住院治疗的严重损伤仍然是一个医疗保健问题，趋势是交通事故减少，家庭创伤增加，老年人受伤增加。这些结果可能有助于规划新的区域性创伤系统。
