From the Center for Clinical Epidemiology and Biostatistics (M.J.K.), Perelman School of Medicine, University of Pennsylvania (B.C., C.A.S.), Philadelphia, Pennsylvania; University of Louisville (M.B.), Louisville, Kentucky.
J Trauma Acute Care Surg. 2013 Sep;75(3):426-31. doi: 10.1097/TA.0b013e31829cfa19.
Organ failure after injury is a significant cause of morbidity and mortality, yet its true incidence is unknown. We sought to benchmark the incidence of organ failure following injury at trauma centers and nontrauma centers using a nationally representative sample of hospital discharges. We hypothesized that injured patients receiving care at trauma centers would have a lower incidence of organ failure than those at nontrauma centers.
We used the 2006 Nationwide Inpatient Sample to identify injured adults (age ≥ 15 years) with organ dysfunction using specific DRG International Classification of Diseases-9th Rev. codes by system. After adjusting for hospital size, geographic region, comorbidities, Injury Severity Score (ISS), age, and sex, a multivariate logistic regression model was created to compare rates of organ dysfunction between trauma centers and nontrauma centers.
We identified 396,276 injured patients, representing the patient care experience of a total of 1,939,473 patients. Among these patients, 6.5% had concurrent organ failure. Injured patients who had acute organ failure were more likely to die than injured patients without organ failure (12.4% vs. 1.7%, p < 0.001). Mortality increased with the number of organ system failures. Patients treated at trauma centers had a higher incidence of respiratory and cardiac failure compared with nontrauma centers.
We offer the first national benchmark of rates of acute organ failure among injured patients. Postinjury organ failure is uncommon, but incidence increases with injury severity and correlates with mortality. Patients at trauma centers had higher rates of respiratory and cardiac failure, possibly representing differences in referral patterns or resuscitation strategies.
Prognostic and epidemiologic study, level III.
器官衰竭是创伤后发病率和死亡率的主要原因，但确切的发病率尚不清楚。我们试图通过对医院出院病人的全国代表性样本，来评估创伤中心和非创伤中心创伤后器官衰竭的发生率。我们假设在创伤中心接受治疗的创伤患者的器官衰竭发生率低于非创伤中心的患者。
我们使用 2006 年全国住院病人样本，通过特定的 DRG 国际疾病分类-9 修订版代码，按系统确定有器官功能障碍的成年受伤患者（年龄≥15 岁）。在调整了医院规模、地理位置、合并症、损伤严重程度评分（ISS）、年龄和性别后，建立了一个多变量逻辑回归模型，以比较创伤中心和非创伤中心之间器官功能障碍的发生率。
我们确定了 396276 名受伤患者，代表了总共 1939473 名患者的医疗经验。在这些患者中，有 6.5%同时存在器官衰竭。有急性器官衰竭的创伤患者比没有器官衰竭的创伤患者更有可能死亡（12.4%对 1.7%，p<0.001）。死亡率随器官系统衰竭数量的增加而增加。与非创伤中心相比，在创伤中心治疗的患者更有可能发生呼吸和心脏衰竭。
我们提供了关于受伤患者急性器官衰竭发生率的第一个全国基准。创伤后器官衰竭并不常见，但随着损伤严重程度的增加而增加，与死亡率相关。在创伤中心治疗的患者呼吸和心脏衰竭的发生率较高，这可能代表了转诊模式或复苏策略的差异。
预后和流行病学研究，III 级。
