因孤立性钝性腹部实体器官损伤患者而收入医院级别的重症加强护理病房。
Hospital-level intensive care unit admission for patients with isolated blunt abdominal solid organ injury.
机构信息
From the Department of Surgery (J.A.B., G.J.J., M.N., G.H.U.), Department of Public Health Sciences (M.N.), and Department of Surgery Outcomes Research Group (G.J.J., G.H.U.), University of California, Davis, Sacramento, California.
出版信息
J Trauma Acute Care Surg. 2020 Mar;88(3):408-415. doi: 10.1097/TA.0000000000002581.
BACKGROUND
The optimal level of care for hemodynamically stable patients with isolated blunt hepatic, renal, or splenic injuries (solid organ injuries [SOIs]) is unknown. We sought to characterize interhospital variability in intensive care unit (ICU) admission of such patients and to determine whether greater hospital-level ICU use would be associated with improved outcomes.
METHODS
We conducted a retrospective cohort study using the 2015 and 2016 National Trauma Data Bank. We included adult patients with blunt trauma with SOIs with an Abbreviated Injury Scale score of 2 to 4. We excluded patients with other significant injuries, hypotension, or another indication for ICU admission, and hospitals with less than 10 eligible patients. We categorized hospitals into quartiles based on the proportion of eligible patients admitted to an ICU. The primary outcome was a composite of organ failure (cardiac arrest, acute lung injury/acute respiratory failure, or acute kidney injury), infection (sepsis, pneumonia, or catheter-related blood stream infection), or death during hospitalization.
RESULTS
Among 14,312 patients at 444 facilities, 7,225 (50%), 5,050 (35%), and 3,499 (24%) had splenic, hepatic, and renal injuries, respectively. The median proportion of ICU use was 44% (interquartile range, 27-59%, range 0-95%). The composite outcome occurred in 180 patients (1.3%), with death in 76 (0.5%), organ failure in 97 (0.7%), and infection in 53 (0.4%). Relative to hospitals with the lowest ICU use (quartile 1), greater hospital-level ICU use was not associated with decreased likelihood of the composite outcome (adjusted odds ratios, 1.31; 95% confidence interval [95% CI], 0.88-1.95; 0.81; 95% CI, 0.52-1.26; and 0.94; 95% CI, 0.62-1.43 for quartiles 2-4, respectively) or its components. Unplanned ICU transfer was no more likely with lower hospital-level ICU use.
CONCLUSION
Admission location of stable patients with isolated mild to moderate abdominal SOIs is variable across hospitals, but hospitalization at a facility with greater ICU use is not associated with substantially improved outcomes.
LEVEL OF EVIDENCE
Therapeutic/care management, Level IV.
背景
对于血流动力学稳定的单纯性肝、肾或脾钝性损伤（实质器官损伤[SOI]）患者，最佳的护理水平尚不清楚。我们试图描述此类患者入住重症监护病房（ICU）的医院间差异，并确定更高的医院 ICU 使用是否与改善结局相关。
方法
我们使用 2015 年和 2016 年国家创伤数据库进行了回顾性队列研究。我们纳入了伴有 SOI（损伤严重程度评分 2 至 4 分）的钝性创伤成年患者。排除了有其他重要损伤、低血压或 ICU 入住其他指征的患者，以及 ICU 合格患者少于 10 人的医院。我们根据 ICU 收治合格患者的比例将医院分为四分位数。主要结局为器官衰竭（心搏骤停、急性肺损伤/急性呼吸窘迫、急性肾损伤）、感染（败血症、肺炎或导管相关血流感染）或住院期间死亡的复合结局。
结果
在 444 家医院的 14312 名患者中，分别有 7225 名（50%）、5050 名（35%）和 3499 名（24%）患者发生脾、肝和肾损伤。ICU 使用的中位数比例为 44%（四分位距 27%至 59%，范围 0%至 95%）。180 名患者（1.3%）发生复合结局，76 名（0.5%）死亡，97 名（0.7%）发生器官衰竭，53 名（0.4%）发生感染。与 ICU 使用最低的医院（四分位 1）相比，更高的医院 ICU 使用与复合结局的可能性降低无关（调整后的优势比，1.31；95%置信区间[95%CI]，0.88-1.95；0.81；95%CI，0.52-1.26；和 0.94；95%CI，0.62-1.43，四分位 2-4 分别）或其组成部分。较低的医院 ICU 使用并不会增加 ICU 计划外转科的可能性。
结论
孤立性轻度至中度腹部 SOI 稳定患者的入院地点在各医院之间存在差异，但入住 ICU 使用较多的医院并不能显著改善结局。
证据等级
治疗/护理管理，IV 级。
Zotero 插件