2002 年至 2010 年美国创伤相关死亡率的流行病学研究。
The epidemiology of trauma-related mortality in the United States from 2002 to 2010.
机构信息
From the Medical School (R.G.S.), University of California, San Francisco; and Trauma Service (R.Y.C.), Scripps Mercy Hospital, San Diego; and Department of Surgery (D.A.S., T.G.W., K.L.S.), Stanford University, Stanford, California.
出版信息
J Trauma Acute Care Surg. 2014 Apr;76(4):913-9; discussion 920. doi: 10.1097/TA.0000000000000169.
BACKGROUND
Epidemiologic trends in trauma-related mortality in the United States require updating and characterization. We hypothesized that during the past decade, there have been changing trends in mortality that are associated with multiple public health and health care-related factors.
METHODS
Multiple sources were queried for the period of 2002 to 2010: the National Trauma Data Bank, the National Centers for Disease Control, the National Highway Traffic Safety Administration, the Nationwide Emergency Department Sample, and the US Census Bureau. The incidence of injury and mortality for motor vehicle traffic (MVT) collisions, firearms, and falls were determined using National Centers for Disease Control data. National Highway Traffic Safety Administration data were used to determine motor vehicle collision information. Injury severity data were derived from the Nationwide Emergency Department Sample and National Trauma Data Bank. Analysis of mortality trends by year was performed using the Cochran-Armitage test for trend. Time-trend multivariable Poisson regression was used to determine risk-adjusted mortality over time.
RESULTS
From 2002 to 2010, the total trauma-related mortality decreased by 6% (p < 0.01). However, mortality trends differed by mechanism. There was a 27% decrease in the MVT death rate associated with a 20% decrease in motor vehicle collisions, 19% decrease in the number of occupant injuries per collision, lower injury severity, and improved outcomes at trauma centers. While firearm-related mortality remained relatively unchanged, mortality caused by firearm suicides increased, whereas homicide-associated mortality decreased (p < 0.001 for both). In contrast, fall-related mortality increased by 46% (5.95-8.70, p < 0.01).
CONCLUSION
MVT mortality rates have decreased during the last decade, owing in part to decreases in the number and severity of injuries. Conversely, fall-related mortality is increasing and is projected to exceed both MVT and firearm mortality rates should current trends continue. Trauma systems and injury prevention programs will need to take into account these changing trends to best accommodate the needs of the injured population.
LEVEL OF EVIDENCE
Epidemiologic study, level III.
背景
美国创伤相关死亡率的流行病学趋势需要更新和描述。我们假设，在过去十年中，死亡率的变化趋势与多种公共卫生和医疗保健相关因素有关。
方法
2002 年至 2010 年期间，我们从多个来源查询了数据：国家创伤数据银行、美国国家疾病控制中心、美国国家公路交通安全管理局、全美急诊部样本和美国人口普查局。使用美国国家疾病控制中心的数据确定了机动车交通（MVT）碰撞、枪支和跌倒造成的伤害发生率和死亡率。美国国家公路交通安全管理局的数据用于确定机动车碰撞信息。损伤严重程度数据来自全美急诊部样本和国家创伤数据银行。使用 Cochran-Armitage 趋势检验分析死亡率随年份的变化趋势。使用时间趋势多变量泊松回归来确定随时间变化的风险调整死亡率。
结果
从 2002 年到 2010 年，与创伤相关的总死亡率下降了 6%（p<0.01）。然而，死亡率趋势因机制而异。与 MVT 死亡率相关的 27%的下降归因于机动车碰撞减少了 20%，每起碰撞中乘客受伤的数量减少了 19%，损伤严重程度降低，创伤中心的治疗效果提高。虽然枪支相关死亡率保持相对不变，但与枪支自杀相关的死亡率增加，而与凶杀相关的死亡率下降（两者均 p<0.001）。相比之下，跌倒相关死亡率增加了 46%（5.95-8.70，p<0.01）。
结论
在过去十年中，MVT 死亡率有所下降，部分原因是受伤人数和严重程度的减少。相反，跌倒相关的死亡率正在上升，如果当前趋势继续下去，预计它将超过 MVT 和枪支死亡率。创伤系统和伤害预防计划将需要考虑到这些变化的趋势，以最好地满足受伤人群的需求。
证据水平
流行病学研究，三级。
Zotero 插件