Kuimi Brice L Batomen, Moore Lynne, Cissé Brahim, Gagné Mathieu, Lavoie André, Bourgeois Gilles, Lapointe Jean
Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada; Institut National de Santé Publique du Québec, QC, Canada.
Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada.
Injury. 2015 Jul;46(7):1257-61. doi: 10.1016/j.injury.2015.02.024. Epub 2015 Mar 9.
Few data are available on population-based access to specialised trauma care and its influence on patient outcomes in an integrated trauma system. We aimed to evaluate the influence of access to an integrate trauma system on in-hospital mortality and length of stay (LOS).
All adults admitted to acute care hospitals for major trauma [International Classification of Diseases Injury Severity Score (ICISS<0.85)] in a Canadian province with an integrated trauma system between 2006 and 2011 were included using an administrative hospital discharge database. The influence of access to an integrated trauma system on in-hospital mortality and LOS was assessed globally and for critically injured patients (ICISS<0.75), according to the type of injury [traumatic brain injury (TBI), abdominal/thoracic, spine, orthopaedic] using logistic and linear multivariable regression models.
We identified 22,749 injury admissions. In-hospital mortality was 7% and median LOS was 9 days for all injuries. Overall, 92% of patients were treated within the trauma system. Globally, patients who did not have access had similar mortality and LOS compared to patients who had access. However, we observed a 62% reduction in mortality for critical abdominal/thoracic injuries (odds ratio=0.38; 95% CI, 0.16-0.92) and an 8% increase in LOS for TBI patients (geometric mean ratio=1.08; 95% CI, 1.02-1.14) treated within the trauma system.
Results provides evidence that in a health system with an integrated mature trauma system, access to specialised trauma care is high and the small proportion of patients treated outside the system, have similar mortality and LOS compared to patients treated within the system. This study suggests that the Québec trauma system performs well in its mandate to offer appropriate treatment to victims of injury that require specialised care.
在综合创伤系统中，关于基于人群获得专业创伤护理的情况及其对患者结局的影响的数据很少。我们旨在评估获得综合创伤系统对住院死亡率和住院时间（LOS）的影响。
利用医院行政出院数据库，纳入2006年至2011年期间在加拿大一个拥有综合创伤系统的省份因重大创伤（国际疾病分类损伤严重度评分[ICISS]<0.85）入住急性护理医院的所有成年人。根据损伤类型[创伤性脑损伤（TBI）、腹部/胸部、脊柱、骨科]，使用逻辑和线性多变量回归模型，全面评估获得综合创伤系统对住院死亡率和住院时间的影响，以及对重伤患者（ICISS<0.75）的影响。
我们确定了22749例损伤入院病例。所有损伤的住院死亡率为7%，中位住院时间为9天。总体而言，92%的患者在创伤系统内接受治疗。总体而言，未获得该系统治疗的患者与获得治疗的患者死亡率和住院时间相似。然而，我们观察到在创伤系统内接受治疗的严重腹部/胸部损伤患者死亡率降低了62%（优势比=0.38；95%置信区间，0.16 - 0.92），TBI患者的住院时间增加了8%（几何平均比=1.08；95%置信区间，1.02 - 1.14）。
结果表明，在一个拥有成熟综合创伤系统的卫生系统中，获得专业创伤护理的比例很高，系统外接受治疗的患者比例很小，其死亡率和住院时间与系统内治疗的患者相似。这项研究表明，魁北克创伤系统在为需要专业护理的受伤受害者提供适当治疗方面表现良好。
