Jung Kyoungwon, Matsumoto Shokei, Smith Alan, Hwang Kyungjin, Lee John Cook-Jong, Coimbra Raul
Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
Department of Surgery, University of California San Diego Health Sciences, San Diego, California, USA.
Trauma Surg Acute Care Open. 2018 Nov 21;3(1):e000238. doi: 10.1136/tsaco-2018-000238. eCollection 2018.
This study aimed to compare treatment outcomes between patients with severe pelvic fractures treated at a representative trauma center that was established in Korea since 2015 and matched cases treated in the USA.
Two cohorts were selected from a single institution trauma database in South Korea (Ajou Trauma Data Bank (ATDB)) and the National Trauma Data Bank (NTDB) in the USA. Adult blunt trauma patients with a pelvic Abbreviated Injury Scale >3 were included. Patients were matched based on covariates that affect mortality rate using a 1:1 propensity score matching (PSM) approach. We compared differences in outcomes between the two groups, performed survival analysis for the cohort after PSM and identified factors associated with mortality. Lastly, we analyzed factors related to outcomes in the ATDB dataset comparing a period prior to the implementation of the trauma center according to US standards, an interim period and a postimplementation period.
After PSM, a total of 320 patients (160 in each cohort) were identified for comparison. Inhospital mortality was significantly higher in the ATDB cohort using χ test, but it was not statistically significant when using Kaplan-Meier survival curves and Cox regression analysis. Moreover, the mortality rate was similar comparing the NTDB cohort to ATDB data reflecting the post-trauma center establishment period. Older age, lower systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) at admission were factors associated with mortality.
Mortality rate after severe pelvic fractures was significantly associated with older age, lower SBP and GCS scores at admission. Efforts to establish a trauma center in South Korea led to improvement in outcomes, which are comparable to those in US centers.
Level IV.
本研究旨在比较自2015年起在韩国一家具有代表性的创伤中心接受治疗的严重骨盆骨折患者与在美国接受治疗的匹配病例的治疗结果。
从韩国单一机构创伤数据库（亚洲大学创伤数据库（ATDB））和美国国家创伤数据库（NTDB）中选取两个队列。纳入骨盆简明损伤量表>3的成年钝性创伤患者。使用1:1倾向评分匹配（PSM）方法，根据影响死亡率的协变量对患者进行匹配。我们比较了两组之间的结果差异，对PSM后的队列进行了生存分析，并确定了与死亡率相关的因素。最后，我们分析了ATDB数据集中与结果相关的因素，比较了根据美国标准创伤中心实施前、实施过渡期和实施后的时间段。
PSM后，共确定320例患者（每个队列160例）进行比较。使用χ检验，ATDB队列的院内死亡率显著更高，但使用Kaplan-Meier生存曲线和Cox回归分析时无统计学意义。此外，将NTDB队列与反映创伤中心建立后时期的ATDB数据进行比较，死亡率相似。年龄较大、入院时收缩压（SBP）较低和格拉斯哥昏迷量表（GCS）评分较低是与死亡率相关的因素。
严重骨盆骨折后的死亡率与年龄较大、入院时SBP和GCS评分较低显著相关。韩国建立创伤中心的努力导致了结果的改善，这与美国中心的结果相当。
四级。
