美国外科医师学会基于需求的创伤系统评估：加利福尼亚州的评估结果
The American College of Surgeons Needs-Based Assessment of Trauma Systems: Estimates for the State of California.
作者信息
Uribe-Leitz Tarsicio, Esquivel Micaela M, Knowlton Lisa M, Ciesla David, Lin Feng, Hsia Renee Y, Spain David A, Winchell Robert J, Staudenmayer Kristan L
机构信息
From the Section of Acute Care Surgery (T.U.L., M.M.E., L.M.K., D.A.S, K.L.S.), Department of Surgery, Stanford University, Stanford, California; Division of Acute Care Surgery (D.C.), Department of Surgery, University of South Florida College of Medicine, Tampa, Florida; Department of Emergency Medicine and Philip R. Lee Institute of Health Policy (F.L., R.Y.H.), University of California San Francisco, San Francisco, California; and Division of Trauma, Burns, Critical and Acute Care (R.J.W.), Department of Surgery, Weill Cornell Medicine, New York, New York.
出版信息
J Trauma Acute Care Surg. 2017 May;82(5):861-866. doi: 10.1097/TA.0000000000001408.
BACKGROUND
In 2015, the American College of Surgeons Committee on Trauma convened a consensus conference to develop the Needs-Based Assessment of Trauma Systems (NBATS) tool to assist in determining the number of trauma centers required for a region. We tested the performance of NBATS with respect to the optimal number of trauma centers needed by region in California.
METHODS
Trauma center data were obtained from the California Emergency Services Authority Information Systems (CEMSIS). Numbers of admitted trauma patients (ISS > 15) were obtained using statewide nonpublic admissions data from the California Office of Statewide Health Planning and Development (OSHPD), CEMSIS, and data from local emergency medical service agency (LEMSA) directors who agreed to participate in a telephone survey. Population estimates per county for 2014 were obtained from the U.S. Census. NBATS criteria used included population, transport time, community support, and number of discharges for severely injured patients (ISS > 15) at nontrauma centers and trauma centers. Estimates for the number of trauma centers per region were created for each of the three data sources and compared to the number of existing centers.
RESULTS
A total of 62 state-designated trauma centers were identified for California: 13 (21%) Level I, 36 (58%) Level II, and 13 (11%) Level III. NBATS estimates for the total number of trauma centers in California were 27% to 47% lower compared to the number of trauma centers in existence, but this varied based on urban/rural status. NBATS estimates were lower than the current state in 70% of urban areas but were higher in almost 90% of rural areas. All data sources (OSHPD, CEMSIS, local data) produced similar results.
CONCLUSION
Estimates from the NBATS tool are different from what is currently in existence in California, and differences exist based on whether the region is rural or urban. Findings from the current study can help inform future iterations of the NBATS tool.
LEVEL OF EVIDENCE
Economic, level V.
背景
2015年，美国外科医师学会创伤委员会召开了一次共识会议，以开发基于需求的创伤系统评估（NBATS）工具，协助确定一个地区所需的创伤中心数量。我们针对加利福尼亚州各地区所需的最佳创伤中心数量测试了NBATS的性能。
方法
创伤中心数据取自加利福尼亚州紧急服务局信息系统（CEMSIS）。使用来自加利福尼亚州全州卫生规划与发展办公室（OSHPD）的全州非公开入院数据、CEMSIS以及同意参与电话调查的当地紧急医疗服务机构（LEMSA）负责人提供的数据，获取创伤患者（损伤严重度评分[ISS]>15）的入院人数。2014年各县的人口估计数取自美国人口普查局。所使用的NBATS标准包括人口、转运时间、社区支持以及非创伤中心和创伤中心重伤患者（ISS>15）的出院人数。针对三个数据源中的每一个，都得出了各地区创伤中心数量的估计值，并与现有中心数量进行比较。
结果
在加利福尼亚州共确定了62个州指定的创伤中心：13个（21%）为一级，36个（58%）为二级，13个（11%）为三级。NBATS对加利福尼亚州创伤中心总数的估计比现有创伤中心数量低27%至47%，但这因城乡状况而异。在70%的城市地区，NBATS的估计值低于当前数量，但在近90%的农村地区则高于当前数量。所有数据源（OSHPD、CEMSIS、当地数据）得出的结果相似。
结论
NBATS工具的估计值与加利福尼亚州目前的情况不同，并且根据该地区是农村还是城市而存在差异。本研究的结果有助于为NBATS工具的未来迭代提供参考。
证据水平
经济，五级。
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