From the Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
J Trauma Acute Care Surg. 2014 Jul;77(1):89-94. doi: 10.1097/TA.0000000000000262.
Little is known about nursing care's impact on trauma outcomes. The Magnet Recognition Program recognizes hospitals for quality patient care and nursing excellence based on objective standards. We hypothesized that Magnet-designated trauma centers would have improved survival over their non-Magnet counterparts.
All 2009 to 2011 admissions to Pennsylvania's Level I and II trauma centers with more than 500 admissions during the study period (10 Magnet and 17 non-Magnet hospitals) were extracted from the Pennsylvania Trauma Systems Foundation State Registry. A logistic regression model with mortality as the dependent variable included the following variables: Magnet status, age, sex, admitting temperature, logit transformation of mortality probability predicted by the Trauma Mortality Prediction Model (TMPM-ais), systolic blood pressure, mechanism of injury, paralytic drug use, and Glasgow Coma Scale motor (GCSm) score.
A total of 73,830 patients from the Pennsylvania Trauma Outcome Study database met inclusion criteria for this study. The Magnet and non-Magnet hospital groups were statistically indistinguishable with respect to level of designation, medical school association, surgical residency programs, in-house surgeons, and urban locations. Patients admitted to a Magnet hospital had a significantly decreased odds of mortality when compared with their non-Magnet counterparts (odds ratio, 0.83; 95% confidence interval, 0.70-0.99; p = 0.033), when controlling for numerous factors. Overall, the model has outstanding discrimination with a receiver operating characteristic curve of 0.93.
Admission to a Magnet-designated hospital is associated with a 20% reduction in mortality. We believe that the Magnet program's attention to nursing competence has important consequences for trauma patients, as reflected in the improved survival rates in trauma patients admitted to Magnet-designated hospitals.
Epidemiologic/prognostic study, level III. Care management study, level IV.
对于护理对创伤结局的影响知之甚少。磁体识别计划基于客观标准，认可为患者提供优质护理和卓越护理的医院。我们假设磁体指定的创伤中心的生存率会高于非磁体对应中心。
从宾夕法尼亚创伤系统基金会州注册处提取了 2009 年至 2011 年期间在宾夕法尼亚州一级和二级创伤中心的所有入院患者，这些中心在研究期间的入院人数超过 500 人（10 家磁体和 17 家非磁体医院）。一个以死亡率为因变量的逻辑回归模型包括以下变量：磁体状态、年龄、性别、入院温度、创伤死亡率预测模型（TMPM-ais）预测的死亡率概率的对数变换、收缩压、损伤机制、使用麻痹药物和格拉斯哥昏迷量表运动（GCSm）评分。
宾夕法尼亚创伤结局研究数据库中的共有 73830 名患者符合本研究的纳入标准。磁体和非磁体医院组在指定级别、医学院协会、外科住院医师计划、内部外科医生和城市位置方面没有统计学差异。与非磁体对应中心相比，入住磁体医院的患者死亡率显著降低（优势比，0.83；95%置信区间，0.70-0.99；p=0.033），同时控制了许多因素。总体而言，该模型具有出色的区分度，接收者操作特征曲线为 0.93。
入住磁体指定医院与死亡率降低 20%相关。我们认为，磁体计划对护理能力的重视对创伤患者具有重要意义，这反映在入住磁体指定医院的创伤患者的生存率提高上。
流行病学/预后研究，III 级。护理管理研究，IV 级。
