Sinai Hospital of Baltimore, Baltimore, MD; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, the Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, the Department of Surgery, Brigham and Women's Hospital, Boston, MA.
J Am Coll Surg. 2019 Jan;228(1):9-20. doi: 10.1016/j.jamcollsurg.2018.09.015. Epub 2018 Oct 22.
Timely access to trauma center (TC) care is critical to achieve "Zero Preventable Deaths after Injury." However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality, and timely access to trauma center care.
We analyzed state-level analysis of adult trauma deaths reported to the CDC Wide-ranging Online Data for Epidemiological Research (WONDER) (1999 to 2016). Correlation between the state-level pre-hospital:in-hospital death ratio (PH:IH), the proportion of population with access to Level-I/II TC, and the age-adjusted mortality rate (AAMR) was determined. Population proportion with timely access to TC care was compared between states with a high pre-hospital death burden vs all other states. National estimates of potentially preventable pre-hospital deaths were calculated.
There were 1,949,375 trauma deaths analyzed. Overall, 1.19 times more deaths occurred pre-hospital (49%, n = 960,554) than in-hospital (42%, n = 810,387). States with better TC access had a lower AAMR (r = -0.71, p < 0.05) and relatively fewer pre-hospital deaths (r = -0.64, p < 0.05); states with higher AAMR had relatively more pre-hospital deaths (r = 0.70, p < 0.05). States with a high pre-hospital death burden had a lower proportion of population with access to Level-I/II TC within 1 hour vs all other states (63.2% vs 90.2%, p < 0.001). If all states had the same PH:IH death ratio as those among the best quartile for access, 129,213 pre-hospital deaths may potentially have been averted.
States with poor TC access have more pre-hospital deaths, which contribute to higher overall injury mortality. This suggests that in these states, improving TC access will be critical to achieve "Zero Preventable Deaths after Injury."
及时获得创伤中心（TC）的治疗对于实现“受伤后零可预防死亡”至关重要。然而，在美国各州，及时获得 TC 治疗对院前死亡的影响尚不清楚。我们旨在确定州一级与院前死亡比例、年龄调整死亡率和及时获得创伤中心治疗之间的关系。
我们分析了向疾病预防控制中心广泛在线数据用于流行病学研究（WONDER）报告的成人创伤死亡的州一级分析（1999 年至 2016 年）。确定州一级院前：院内死亡比例（PH：IH）、可获得一级/二级 TC 的人口比例和年龄调整死亡率（AAMR）之间的相关性。比较高院前死亡负担州与所有其他州之间及时获得 TC 治疗的人口比例。计算了潜在可预防的院前死亡人数的全国估计数。
共分析了 1949375 例创伤死亡病例。总体而言，院前死亡（49%，n=960554）比院内死亡（42%，n=810387）多 1.19 倍。TC 可及性较好的州的 AAMR 较低（r=-0.71，p<0.05），相对较少的院前死亡（r=-0.64，p<0.05）；AAMR 较高的州相对较多的院前死亡（r=0.70，p<0.05）。院前死亡负担较高的州，在 1 小时内获得一级/二级 TC 的人口比例低于所有其他州（63.2%对 90.2%，p<0.001）。如果所有州的 PH：IH 死亡率都与最佳四分位access 中的那些州相同，那么 129213 例院前死亡可能本可以避免。
TC 可及性差的州有更多的院前死亡，这导致了更高的整体伤害死亡率。这表明，在这些州，改善 TC 可及性对于实现“受伤后零可预防死亡”至关重要。
