是否到了从国家创伤数据库（National Trauma Data Bank）衡量并发症的时候了？近期报告趋势的纵向分析。
Is it time to measure complications from the National Trauma Data Bank? A longitudinal analysis of recent reporting trends.
机构信息
From the Department of Surgery (A.J.R., A.S.C., R.A.C.), San Francisco General Hospital; University of California (A.J.R., A.S.C., R.A.C.), San Francisco, California; Department of Surgery (M.J.C.), Denver Health Medical Center; and University of Colorado (M.J.C.), Denver, Colorado.
出版信息
J Trauma Acute Care Surg. 2019 Feb;86(2):282-288. doi: 10.1097/TA.0000000000002133.
BACKGROUND
Payers have approached select complications as never events, yet there is rationale that achieving a zero incidence of these events is impractical. Prior 2005 National Trauma Data Bank (NTDB) analysis showed high rates (37%) of centers reporting no complications data making national estimates for determining standardized complication rates difficult to ascertain.
METHODS
The 2008-2012 NTDB National Sample Program nationally weighted files were used to calculate yearly national estimates. Rates were compared in all centers and those reporting complications data. Hospital characteristics were compared using Student t test. In 2011, an other complication category was introduced; overall rates were calculated with and without this category. Yearly estimates were reported for patients receiving care within centers reporting complications data.
RESULTS
From 2008-2012 NTDB, there were raw data on 3,657,884 patients. A total of 594,894 patients (16.3%) experienced one or more complications (82.7% one complication; 17.3% two or more complications). Excluding the other complication category, the overall weighted rate was 8.4% to 9.2%. Pneumonia was the most common complication (2.7-3.0%), occurring at twice the 2005 rate. The number of centers reporting no complications data dropped to 8.1% in 2011 (2008, 14.5%; 2009, 18.2%; 2010, 15.9%; 2012, 8.9%). By 2012, nearly all level I centers reported complications, whereas 46.4% of level IVs reported none (I 0.5%, II 2.7%, III 8.5%, p = 0.04). Data were reported the least frequently in nonteaching hospitals (15.8%, p = 0.007), those in the South (19.6%, p = 0.007), and those with less than 200 beds (23.6%, p = 0.005).
CONCLUSION
Overall rates of complications from 2008 to 2012 were nearly twofold higher than 2005 data. Reporting has increased, and NTDB may provide a valuable platform for establishing rational and achievable measures for specific complications.
LEVEL OF EVIDENCE
Prognostic and epidemiological, level IV.
背景
支付方已将某些并发症视为永不发生事件，但也有合理的理由表明，实现这些事件的零发生率是不切实际的。在 2005 年之前的国家创伤数据库（NTDB）分析中，有 37%的中心报告没有并发症数据，这使得确定标准化并发症发生率的全国估计值变得困难。
方法
使用 2008-2012 年 NTDB 国家样本计划全国加权文件计算每年的全国估计值。在所有中心和报告并发症数据的中心比较了比率。使用学生 t 检验比较医院特征。2011 年引入了另一个并发症类别；计算时包括和不包括该类别，计算了总体比率。报告了在报告并发症数据的中心接受治疗的患者的年度估计值。
结果
2008-2012 年 NTDB 有 3657884 名患者的原始数据。共有 594894 名患者（16.3%）经历了一种或多种并发症（82.7%一种并发症；17.3%两种或多种并发症）。不包括其他并发症类别，总体加权率为 8.4%至 9.2%。肺炎是最常见的并发症（2.7-3.0%），发生率是 2005 年的两倍。报告无并发症数据的中心数量从 2008 年的 14.5%降至 2011 年的 8.1%（2009 年为 18.2%；2010 年为 15.9%；2012 年为 8.9%）。到 2012 年，几乎所有一级中心都报告了并发症，而 46.4%的四级中心则没有报告（一级为 0.5%，二级为 2.7%，三级为 8.5%，p=0.04）。非教学医院报告数据的频率最低（15.8%，p=0.007），南方医院报告数据的频率最低（19.6%，p=0.007），床位少于 200 张的医院报告数据的频率最低（23.6%，p=0.005）。
结论
2008 年至 2012 年的并发症总发生率几乎是 2005 年数据的两倍。报告有所增加，NTDB 可能为确定特定并发症的合理和可实现措施提供有价值的平台。
证据水平
预后和流行病学，IV 级。
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