跨医院系统进行区域化管理后，创伤性脑损伤死亡率降低。
Decreased mortality in traumatic brain injury following regionalization across hospital systems.
作者信息
Kelly Michael L, Banerjee Aman, Nowak Michael, Steinmetz Michael, Claridge Jeffrey A
机构信息
From the Department of Neurosurgery (M.L.K.), Neurological Institute, Cleveland Clinic; Department of Neurosurgery (M.S.), MetroHealth Medical Center (A.B., M.N., J.A.C.); Northern Ohio Trauma System (A.B., M.N., J.A.C.); Department of Surgery (A.B., M.N., J.A.C.), Case Western Reserve University School of Medicine, Cleveland, Ohio.
出版信息
J Trauma Acute Care Surg. 2015 Apr;78(4):715-20. doi: 10.1097/TA.0000000000000590.
BACKGROUND
The Northern Ohio Trauma System (NOTS) was established to improve outcomes of trauma patients across the region. We hypothesized that mortality in patients with traumatic brain injury (TBI) would improve after regionalization.
METHODS
All patients older than 14 years with a TBI were identified from NOTS, a regional trauma system consisting of two large health care systems and regional emergency medical services providers. Data from 2008 through 2012 were analyzed before and after NOTS formation in 2010. Multivariate logistic regression analysis was performed to evaluate independent predictors of survival.
RESULTS
A total of 11,220 patients were identified with TBI in the NOTS database, 4,507 (40%) before NOTS and 6,713 (60%) after NOTS formation. Admissions to the regional Level 1 center post-NOTS formation increased from 36% to 46% (p < 0.0001). Injury Severity Scores (ISSs) and Abbreviated Injury Scale (AIS) scores were similar between periods. The mortality rate decreased from 6.2% to 4.9% (p = 0.005) among all TBIs and from 19% to 14% (p < 0.0001) in TBIs with a head AIS score of 3 or greater (n = 3,538). Craniotomy procedures increased from 1.8% to 2.7% (p = 0.003) overall and from 5.9% to 8.1% (p = 0.02) in TBIs with head AIS score of 3 or greater. Logistic regression analysis demonstrated an independent effect on survival for post-NOTS period in all patients (odds ratio, 0.76; 95% confidence interval, 0.62-0.94; C statistic = 0.96) and in TBIs with head AIS score of 3 or greater (odds ratio, 0.72; 95% confidence interval, 0.58-0.89; C statistic = 0.86).
CONCLUSION
Regionalization of trauma care across hospital systems is associated with a reduced mortality rate for patients with TBI, particularly for patients with a head AIS score of 3 or greater. Mortality decreased by 24% for all TBIs and by 28% for severe TBIs. These findings support regionalization of trauma care with collaboration and consolidation of care across health care systems.
LEVEL OF EVIDENCE
Therapeutic/care management, level IV; epidemiologic study, level III.
背景
俄亥俄州北部创伤系统（NOTS）的建立旨在改善该地区创伤患者的治疗效果。我们假设创伤性脑损伤（TBI）患者的死亡率在区域化后会有所改善。
方法
从NOTS（一个由两个大型医疗系统和区域紧急医疗服务提供者组成的区域创伤系统）中识别出所有年龄大于14岁的TBI患者。对2008年至2012年的数据在2010年NOTS形成前后进行了分析。进行多因素逻辑回归分析以评估生存的独立预测因素。
结果
在NOTS数据库中总共识别出11220例TBI患者，NOTS形成前有4507例（40%），形成后有6713例（60%）。NOTS形成后区域一级中心的入院率从36%增加到46%（p<0.0001）。不同时期的损伤严重程度评分（ISS）和简明损伤定级（AIS）评分相似。所有TBI患者的死亡率从6.2%降至4.9%（p=0.005），头部AIS评分为3或更高的TBI患者（n=3538）的死亡率从19%降至14%（p<0.0001）。开颅手术总体上从1.8%增加到2.7%（p=0.003），头部AIS评分为3或更高的TBI患者中从5.9%增加到8.1%（p=0.02）。逻辑回归分析表明，NOTS形成后时期对所有患者的生存有独立影响（比值比，0.76；95%置信区间，0.62 - 0.94；C统计量 = 0.96），对头部AIS评分为3或更高的TBI患者也有独立影响（比值比，0.72；95%置信区间，0.58 - 0.89；C统计量 = 0.86）。
结论
跨医院系统的创伤护理区域化与TBI患者死亡率降低相关，特别是对于头部AIS评分为3或更高的患者。所有TBI患者的死亡率降低了24%，严重TBI患者降低了28%。这些发现支持通过跨医疗系统的协作和护理整合实现创伤护理区域化。
证据级别
治疗/护理管理，IV级；流行病学研究，III级。
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