标准创伤数据源遗漏的死亡病例和高风险创伤患者。
Deaths and high-risk trauma patients missed by standard trauma data sources.
作者信息
Newgard Craig D, Fu Rongwei, Lerner E Brooke, Daya Mohamud, Wright Dagan, Jui Jonathan, Mann N Clay, Bulger Eileen, Hedges Jerris, Wittwer Lynn, Lehrfeld David, Rea Thomas
机构信息
From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (C.D.N., M.D., J.J.), Oregon Health & Science University Portland, Oregon; Department of Public Health and Preventive Medicine (R.F., D.W.), Oregon Health & Science University, Portland, Oregon; Department of Emergency Medicine (E.B.L.), Medical College of Wisconsin, Milwaukee, Wisconsin; Tualatin Valley Fire & Rescue (M.D.), Tualatin, Oregon; Injury and Violence Prevention Section Oregon Health Authority (D.W.), Portland, Oregon; Emergency Medical Services & Trauma Systems (D.W., D.L.), Oregon Health Authority, Portland Oregon; Multnomah County Emergency Medical Services (J.J.), Portland, Oregon; Intermountain Injury Control Research Center, Department of Pediatrics (N.C.M.), University of Utah, Salt Lake City, Utah; Department of Surgery (E.B.), University of Washington, Seattle, Washington; Department of Medicine (J.H.), John A. Burns School of Medicine, University of Hawaii-Manoa, Honolulu, Hawaii; Clark Regional Emergency Services Agency (L.W.), Vancouver, Washington; PeaceHealth Southwest Medical Center (L.W.), Vancouver, Washington; Department of Internal Medicine (T.R.), University of Washington; King County Emergency Medical Services (T.R.), Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2017 Sep;83(3):427-437. doi: 10.1097/TA.0000000000001616.
BACKGROUND
Trauma registries are used to evaluate and improve trauma care, yet potentially miss certain trauma deaths and high-risk patients. We estimated the number of missed deaths and high-risk trauma patients using commonly available sources of trauma data and resulting bias in quality metrics for field trauma triage.
METHODS
This was a preplanned secondary analysis of a population-based prospective cohort of injured patients transported by 44 emergency medical services agencies to 28 hospitals in seven Northwest counties from January 1, 2011 to December 31, 2011 and followed through hospitalization. We used a stratified probability sampling design for 17,633 patients, weighted to represent all 53,487 injured patients transported by emergency medical services. We compared patients meeting National Trauma Data Bank (NTDB) criteria (weighted n = 5,883), all injured patients presenting to major trauma centers (weighted n = 16,859), and all admitted patients (weighted n = 18,433), to the full sample. Outcomes included in-hospital mortality, Injury Severity Score (ISS) of 16 or higher, and critical resource use within 24 hours.
RESULTS
Among 53,487 injured patients, there were 520 emergency department and in-hospital deaths, 1,745 with ISS of 16 or higher, and 923 requiring early critical resources. Compared to the full cohort, the NTDB cohort missed 62.1% of deaths, 39.2% of patients with ISS of 16 or higher, and 23.8% requiring early critical resources, especially older adults injured by falls and admitted to nontrauma hospitals. The admission cohort missed the fewest patients-23.3% of deaths, 10.5% with an ISS of 16 or higher, and 13.1% requiring early resources. Compared to triage sensitivity in the full cohort (66.2%), sensitivity estimates ranged from 63.6% (all admissions) to 93.4% (NTDB). Compared to triage specificity in the full cohort (87.8%), estimates ranged from 36.4% (NTDB) to 77.3% (all admissions).
CONCLUSION
Common sources of trauma data miss substantial numbers of trauma deaths and high-risk trauma patients and can generate biased estimates for trauma system quality metrics.
LEVEL OF EVIDENCE
Epidemiologic, level III.
背景
创伤登记系统用于评估和改善创伤护理，但可能会遗漏某些创伤死亡病例和高危患者。我们使用常用的创伤数据来源估计了遗漏的死亡病例数和高危创伤患者数量，以及由此导致的现场创伤分诊质量指标偏差。
方法
这是一项对基于人群的前瞻性队列进行的预先计划的二次分析，该队列中的受伤患者由44个紧急医疗服务机构于2011年1月1日至2011年12月31日转运至西北七个县的28家医院，并随访至住院结束。我们对17,633名患者采用分层概率抽样设计，并进行加权以代表由紧急医疗服务转运的所有53,487名受伤患者。我们将符合国家创伤数据库（NTDB）标准的患者（加权n = 5,883）、所有前往大型创伤中心就诊的受伤患者（加权n = 16,859）以及所有入院患者（加权n = 18,433）与完整样本进行比较。结局指标包括院内死亡率、损伤严重度评分（ISS）为16或更高，以及24小时内的关键资源使用情况。
结果
在53,487名受伤患者中，有520例在急诊科和住院期间死亡，1,745例ISS为16或更高，923例需要早期关键资源。与完整队列相比，NTDB队列遗漏了62.1%的死亡病例、39.2%的ISS为16或更高的患者以及23.8%需要早期关键资源的患者，尤其是因跌倒受伤并入住非创伤医院的老年人。入院队列遗漏的患者最少——23.3%的死亡病例、10.5%的ISS为16或更高的患者以及13.1%需要早期资源的患者。与完整队列中的分诊敏感性（66.2%）相比，敏感性估计范围为63.6%（所有入院患者）至93.4%（NTDB）。与完整队列中的分诊特异性（87.8%）相比，估计范围为36.4%（NTDB）至77.3%（所有入院患者）。
结论
常用的创伤数据来源遗漏了大量创伤死亡病例和高危创伤患者，并可能对创伤系统质量指标产生有偏差的估计。
证据级别
流行病学，III级。
Zotero 插件