区域创伤网络的绩效：全州范围分析。

Performance of a regional trauma network: A state-wide analysis.

作者信息

He Jack C, Kreiner Laura A, Sajankila Nitin, Allen Debra L, Claridge Jeffrey A

机构信息

Department of Surgery (J.C.H., L.A.L., J.A.C.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; and Case Western Reserve University School of Medicine (N.S), Cleveland, Ohio; Northern Ohio Trauma System (D.L.A.), Cleveland, Ohio.

出版信息

J Trauma Acute Care Surg. 2016 Jul;81(1):190-5. doi: 10.1097/TA.0000000000001067.

DOI:10.1097/TA.0000000000001067

PMID:27032008

Abstract

BACKGROUND

The Northern Ohio Trauma System (NOTS), established in 2010, is a collaborative regional trauma system composed of one level I and several lower-level trauma centers (TCs) across multiple hospital systems. Mortalities between counties in NOTS and other Ohio counties were compared to assess NOTS performance.

METHODS

State trauma registry was analyzed for patients 15 years or older from 2006 to 2012. Mortality change over time was assessed by comparing all counties before and after NOTS establishment. Two analyses were done in the post-NOTS period: (1) a county analysis, comparing Cuyahoga County, the county containing NOTS level I TC (L1TC), with other counties containing L1TCs and (2) a regional analysis, comparing Cuyahoga and its adjacent counties (i.e., the NOTS region) with other L1TC containing regions. The following subgroups were included a priori: Injury Severity Score 15 or greater, age 65 years or older, and trauma mechanism.

RESULTS

A total of 178,143 patients were analyzed. Cuyahoga was the only county that had a decrease in mortality for both the overall group and all subgroups over time (all p < 0.05). Both the county and regional analyses showed that the overall NOTS patients were 1 to 4 years older (p < 0.05), had similar or higher Injury Severity Score (p < 0.05), and were treated more often at lower-level TCs (p < 0.001). County analysis demonstrated that Cuyahoga County had approximately 1% lower mortality in geriatrics patients compared with non-NOTS counties. Regional analysis showed lower mortality in the NOTS region for the overall patient group, as well as geriatric and blunt injuries subgroups.

CONCLUSIONS

Cuyahoga was the only county in Ohio that had significant mortality reduction for all patient groups over time. Trauma system regionalization was associated with greater utilization of lower-level TCs and lower patient mortality. These findings suggest that a collaborative regional trauma system may be more important than the number of L1TC in an area.

LEVEL OF EVIDENCE

Therapeutic/care management study, level IV.

摘要

背景

俄亥俄州北部创伤系统（NOTS）于2010年建立，是一个合作性的区域创伤系统，由一个一级创伤中心和多个医院系统中的几个较低级别的创伤中心组成。比较了NOTS所在县与俄亥俄州其他县之间的死亡率，以评估NOTS的绩效。

方法

对2006年至2012年15岁及以上患者的州创伤登记数据进行分析。通过比较NOTS建立前后所有县的死亡率变化来评估死亡率随时间的变化。在NOTS建立后进行了两项分析：（1）县分析，将包含NOTS一级创伤中心（L1TC）的库亚霍加县与其他包含L1TC的县进行比较；（2）区域分析，将库亚霍加县及其相邻县（即NOTS区域）与其他包含L1TC的区域进行比较。预先设定纳入以下亚组：损伤严重程度评分15分或更高、年龄65岁或以上以及创伤机制。

结果

共分析了178,143例患者。库亚霍加县是唯一一个总体组和所有亚组的死亡率随时间下降的县（所有p<0.05）。县分析和区域分析均显示，NOTS的总体患者年龄大1至4岁（p<0.05），损伤严重程度评分相似或更高（p<0.05），且在较低级别的创伤中心接受治疗的频率更高（p<0.001）。县分析表明，与非NOTS县相比，库亚霍加县老年患者的死亡率低约1%。区域分析显示，NOTS区域总体患者组以及老年和钝性损伤亚组的死亡率较低。