距离至关重要：地理创伤系统资源组织对致命机动车碰撞事故的影响。
Distance matters: Effect of geographic trauma system resource organization on fatal motor vehicle collisions.
作者信息
Brown Joshua B, Rosengart Matthew R, Billiar Timothy R, Peitzman Andrew B, Sperry Jason L
机构信息
From the Division of Trauma and General Surgery, Department of Surgery (J.B.B., M.R.R., T.R.B., A.B.P., J.L.S.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2017 Jul;83(1):111-118. doi: 10.1097/TA.0000000000001508.
BACKGROUND
Trauma systems improve outcome; however, it is unclear how geographic organization of trauma system resources (TSR) affects outcome. Our objective was to evaluate the relationship of fatal motor vehicle collision (MVC) rates and the distance from individual MVC locations to the nearest TSR as a measure of the geographical organization of trauma systems, as well as how theoretical changes in the distribution of TSR may affect fatal MVC rates.
METHODS
All fatal MVC in Pennsylvania 2013-2014 were mapped from the Fatality Analysis Reporting System database. Deaths on scene were excluded. TSR including trauma centers and helicopter bases were mapped. Distance between each fatal MVC and nearest TSR was calculated. The primary outcome was fatal MVC rate per 100 million vehicle miles traveled (VMT). Empiric Bayes kriging and hot spot analysis were performed to evaluate geographic patterns in fatal MVC rates. Association between fatal MVC rate and distance to the nearest TSR was evaluated with linear regression. Spatial lag regression evaluated this association while controlling for MVC and county-level characteristics.
RESULTS
We identified 886 fatalities from 863 fatal MVC. Median fatal MVC rate was 0.187 per 100 million VMT. Higher fatal MVC rates and fatality hot spots occur in locations farther from TSR. The fatal MVC rate increased 0.141 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). When controlling for confounders, the fatal MVC rate increased by 0.089 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). If two helicopters stationed at trauma centers were relocated into the highest fatality regions, our model predicts a 12.3% relative reduction in the overall MVC fatality rate.
CONCLUSIONS
Increasing distance to the nearest TSR is associated with increasing fatal MVC rate. The geographic organization of trauma systems may impact outcome, and geospatial analysis can allow data-driven changes to potentially improve outcome.
LEVEL OF EVIDENCE
Prognostic/Epidemiologic, level III; Case management, level III.
背景
创伤系统可改善治疗结果；然而，尚不清楚创伤系统资源（TSR）的地理组织如何影响治疗结果。我们的目标是评估致命机动车碰撞（MVC）发生率与从单个MVC地点到最近TSR的距离之间的关系，以此作为创伤系统地理组织的一种衡量指标，以及TSR分布的理论变化可能如何影响致命MVC发生率。
方法
从死亡分析报告系统数据库中绘制出2013 - 2014年宾夕法尼亚州所有致命MVC的地图。排除现场死亡情况。绘制包括创伤中心和直升机基地在内的TSR地图。计算每次致命MVC与最近TSR之间的距离。主要结局是每亿车英里行驶里程（VMT）的致命MVC发生率。进行经验贝叶斯克里金法和热点分析以评估致命MVC发生率的地理模式。采用线性回归评估致命MVC发生率与到最近TSR距离之间的关联。空间滞后回归在控制MVC和县级特征的同时评估这种关联。
结果
我们从863起致命MVC中识别出886例死亡。致命MVC发生率中位数为每亿VMT 0.187例。在距离TSR较远的地点，致命MVC发生率更高且存在死亡热点。与最近TSR的距离每增加10英里，致命MVC发生率每亿VMT增加0.141例（p < 0.01）。在控制混杂因素时，与最近TSR的距离每增加10英里，致命MVC发生率每亿VMT增加0.089例（p < 0.01）。如果将驻扎在创伤中心的两架直升机重新部署到死亡人数最多的地区，我们的模型预测总体MVC死亡率将相对降低12.3%。
结论
与最近TSR的距离增加与致命MVC发生率增加相关。创伤系统的地理组织可能会影响治疗结果，地理空间分析可以实现基于数据的改变，从而有可能改善治疗结果。
证据水平
预后/流行病学，III级；病例管理，III级。
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