经美国外科医师学会创伤委员会认证的一级和二级创伤中心的特征：一项将创伤中心认证审查数据与美国外科医师学会创伤委员会国家创伤数据库相联系的研究。
Characteristics of ACS-verified Level I and Level II trauma centers: A study linking trauma center verification review data and the National Trauma Data Bank of the American College of Surgeons Committee on Trauma.
作者信息
Shafi Shahid, Barnes Sunni, Ahn Chul, Hemilla Mark R, Cryer H Gill, Nathens Avery, Neal Melanie, Fildes John
机构信息
From the Office of the Chief Quality Officer (S.S., S.B.), Baylor Scott & White Health, Dallas, Texas; Department of Clinical Science (C.A.), UT Southwestern Medical Center, Dallas, Texas; Department of Surgery (M.R.H.), University of Michigan Health System, Ann Arbor, Michigan; Trauma and Emergency Services Department (H.G.C.), University of California, Los Angeles, California; Division of General Surgery (A.N.), Sunnybrook Health Sciences Centre; Department of Surgery, University of Toronto, Toronto, Canada; American College of Surgeons National Trauma Data Bank (M.N.), Chicago, Illinois; and Department of Surgery (J.F.), University of Nevada School of Medicine, Las Vegas, Nevada.
出版信息
J Trauma Acute Care Surg. 2016 Oct;81(4):735-42. doi: 10.1097/TA.0000000000001136.
BACKGROUND
The Trauma Quality Improvement Project of the American College of Surgeons (ACS) has demonstrated variations in trauma center outcomes despite similar verification status. The purpose of this study was to identify structural characteristics of trauma centers that affect patient outcomes.
METHODS
Trauma registry data on 361,187 patients treated at 222 ACS-verified Level I and Level II trauma centers were obtained from the National Trauma Data Bank of ACS. These data were used to estimate each center's observed-to-expected (O-E) mortality ratio with 95% confidence intervals using multivariate logistic regression analysis. De-identified data on structural characteristics of these trauma centers were obtained from the ACS Verification Review Committee. Centers in the lowest quartile of mortality based on O-E ratio (n = 56) were compared to the rest (n = 166) using Classification and Regression Tree (CART) analysis to identify institutional characteristics independently associated with high-performing centers.
RESULTS
Of the 72 structural characteristics explored, only 3 were independently associated with high-performing centers: annual patient visits to the emergency department of fewer than 61,000; proportion of patients on Medicare greater than 20%; and continuing medical education for emergency department physician liaison to the trauma program ranging from 55 and 113 hours annually. Each 5% increase in O-E mortality ratio was associated with an increase in total length of stay of one day (r = 0.25; p < 0.001).
CONCLUSIONS
Very few structural characteristics of ACS-verified trauma centers are associated with risk-adjusted mortality. Thus, variations in patient outcomes across trauma centers are likely related to variations in clinical practices.
LEVEL OF EVIDENCE
Therapeutic study, level III.
背景
美国外科医师学会（ACS）的创伤质量改进项目表明，尽管创伤中心的认证状态相似，但各创伤中心的治疗结果仍存在差异。本研究的目的是确定影响患者治疗结果的创伤中心结构特征。
方法
从ACS的国家创伤数据库中获取了在222个经ACS认证的一级和二级创伤中心接受治疗的361,187例患者的创伤登记数据。使用多变量逻辑回归分析，利用这些数据来估计每个中心的观察到预期（O-E）死亡率，并给出95%置信区间。这些创伤中心结构特征的去识别化数据来自ACS认证审查委员会。根据O-E比率将死亡率处于最低四分位数的中心（n = 56）与其余中心（n = 166）进行比较，采用分类与回归树（CART）分析来确定与高绩效中心独立相关的机构特征。
结果
在探索的72个结构特征中，只有3个与高绩效中心独立相关：急诊科年患者就诊量少于61,000人次；医疗保险患者比例大于20%；以及创伤项目急诊科医师联络人的继续医学教育时长为每年55至113小时。O-E死亡率每增加5%，住院总时长就会增加一天（r = 0.25；p < 0.001）。
结论
经ACS认证的创伤中心中，很少有结构特征与风险调整后的死亡率相关。因此，各创伤中心患者治疗结果的差异可能与临床实践的差异有关。
证据级别
治疗性研究，三级。
Zotero 插件