两个斯堪的纳维亚一级创伤中心风险调整后生存率的比较。
Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres.
作者信息
Ghorbani Poya, Ringdal Kjetil Gorseth, Hestnes Morten, Skaga Nils Oddvar, Eken Torsten, Ekbom Anders, Strömmer Lovisa
机构信息
Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
Department of Anaesthesiology, Vestfold Hospital Trust, Tønsberg, Norway.
出版信息
Scand J Trauma Resusc Emerg Med. 2016 May 10;24:66. doi: 10.1186/s13049-016-0257-9.
BACKGROUND
Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres.
METHODS
This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolinska University Hospital - Solna (KUH), Sweden, and Oslo University Hospital - Ullevål (OUH), Norway, from 2009-2011. Probability of survival (Ps) was calculated according to the Trauma and Injury Severity Score (TRISS) method. Risk-adjusted survival per patient was calculated by assigning every patient a value corresponding to gained or lost fractional life: Each survivor contributed a reward of 1-Ps and each death a penalty of -Ps. The sum of penalties and rewards, corresponding to the difference between expected and actual mortality, was compared between the centres. We present the data as excess survivors per 100 trauma patients.
RESULTS
There were 4485 admissions at KUH and 3591 at OUH. The proportion of severely injured patients was higher at OUH compared with KUH (Injury Severity Score [ISS] >15: 33.9 % vs. 21.1 %, p <0.001). OUH had a larger proportion of patients >65 years (16.0 % vs. 13.4 %, p <0.001) and greater comorbidity (ASA-PS ≥3: 14.6 % vs. 6.9 %, p <0.001) compared with KUH. The frequency of helicopter transport and presence of prehospital physicians was higher at OUH compared with KUH (27.6 % vs. 15.5 % and 30.5 % vs. 3.7 %, both p <0.001). Secondary admissions were 5.2-fold more common at OUH compared with KUH (p <0.001). There were no differences in 30-day mortality for severely injured patients (ISS >15). Risk-adjusted survival rate was higher at OUH than at KUH for primary (0.59 vs. 0.51) but lower for secondary (1.41 vs. 2.85) admissions (both p <0.001).
CONCLUSION
Adjustments for age as a continuous variable and comorbidity should be made when comparing risk-adjusted survival between hospitals, but this is not possible with the TRISS model. A survival prediction model that takes this into account may be a better choice for Scandinavian trauma populations. The current study could not rule out the influence of the system differences between the centres on risk-adjusted survival.
背景
评估创伤系统的性能对于改善受伤患者的护理至关重要。本研究的目的是比较两个斯堪的纳维亚一级创伤中心经风险调整后的生存率。
方法
这是一项观察性回顾性研究，对2009年至2011年期间瑞典卡罗林斯卡大学医院索尔纳分院（KUH）和挪威奥斯陆大学医院乌勒瓦尔分院（OUH）14岁以上患者的前瞻性收集的创伤登记数据进行分析。根据创伤和损伤严重程度评分（TRISS）方法计算生存概率（Ps）。通过为每位患者分配一个与获得或失去的分数生命相对应的值来计算每位患者的经风险调整后的生存率：每位幸存者贡献1 - Ps的奖励，每位死亡患者贡献 - Ps的惩罚。比较两个中心惩罚和奖励的总和，即预期死亡率与实际死亡率之间的差异。我们将数据表示为每100名创伤患者中的额外幸存者数量。
结果
KUH有4485例入院患者，OUH有3591例。与KUH相比，OUH重伤患者的比例更高（损伤严重程度评分[ISS] >15：33.9%对21.1%，p <0.001）。与KUH相比，OUH 65岁以上患者的比例更大（16.0%对13.4%，p <0.001），合并症更多（美国麻醉医师协会身体状况评分[ASA - PS]≥3：14.6%对6.9%，p <0.001）。与KUH相比，OUH直升机转运的频率和院前医生的配备更高（27.6%对15.5%以及30.5%对3.7%，p均<0.001）。与KUH相比，OUH二次入院的情况常见5.2倍（p <0.001）。重伤患者（ISS >15）的30天死亡率没有差异。OUH原发性入院的经风险调整后的生存率高于KUH（0.59对0.51），但继发性入院的经风险调整后的生存率低于KUH（1.41对2.85）（p均<0.001）。
结论
在比较医院间经风险调整后的生存率时，应将年龄作为连续变量和合并症进行调整，但TRISS模型无法做到这一点。考虑到这一点的生存预测模型可能是斯堪的纳维亚创伤人群的更好选择。本研究无法排除中心间系统差异对经风险调整后的生存率的影响。
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