佛罗里达州大型创伤网络建立后创伤患者的老年病学结局。

Geriatric outcomes for trauma patients in the state of Florida after the advent of a large trauma network.

机构信息

From Ocala Regional Medical Center, Ocala, Florida.

出版信息

J Trauma Acute Care Surg. 2014 Jul;77(1):155-60; discussion 160. doi: 10.1097/TA.0000000000000272.

DOI:10.1097/TA.0000000000000272

PMID:24977771

Abstract

BACKGROUND

Florida State has one of the largest geriatric populations in the United States. However, recent data show that up to the year 2010, geriatric trauma patients were least served by designated trauma centers (TCs). One existing TC and five provisional Level 2 TCs were combined to create a large-scale trauma network (TN). The new TCs were placed in those areas with the lowest ratios of TC to residents based on census data. The aim of this study was to measure the TN impact on the population of geriatric trauma patients.

METHODS

Data from the Florida State Agency for Health Care Administration were used to determine mortality, length of stay, and complication rates for geriatric trauma patients (≥ 65 years). The potential effect of the TN was measured by comparing outcomes before and after the initiation of the TN. A total of 165,640 geriatric patients were evaluated. Multivariate regression methods were used to match and adjust for age, injury status (penetrating vs. nonpenetrating), sex, race, comorbidity, and injury severity (DRG International Classification of Diseases-9th Rev. Injury Severity Score).

RESULTS

Since the advent of the TN, an additional 1,711 geriatric patients were treated compared with the previous period. The TN was responsible 86% of these new patients. There was a temporal association with a decrease in both mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.85-0.96) and length of stay (p < 0.0001) for geriatric patients since the advent of the TN. The improved access was associated with a significant decrease in mortality in the regions serviced by the TN.

CONCLUSION

Geriatric patients make up a significant proportion of trauma patients within the TN. The temporal improvement in outcomes may be associated with the increased proportion of patients being treated in state-designated TCs as a result of the addition of the TN.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

摘要

背景

佛罗里达州拥有美国最大的老年人口之一。然而，最近的数据表明，到 2010 年为止，老年创伤患者是指定创伤中心（TC）服务最少的人群。一个现有的 TC 和五个临时的 2 级 TC 被合并为一个大型创伤网络（TN）。根据人口普查数据，新的 TC 被安置在那些 TC 与居民比例最低的地区。这项研究的目的是衡量 TN 对老年创伤患者人群的影响。

方法

使用佛罗里达州卫生保健管理局的数据来确定老年创伤患者（≥65 岁）的死亡率、住院时间和并发症发生率。通过比较 TN 启动前后的结果来衡量 TN 的潜在影响。共评估了 165640 名老年患者。使用多变量回归方法来匹配和调整年龄、损伤状态（穿透性与非穿透性）、性别、种族、合并症和损伤严重程度（DRG 国际疾病分类第 9 版修订损伤严重程度评分）。