Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA.
Clinical Research Center, Fundación Valle del Lili, Carrera 98, #18-49, Cali, Colombia.
World J Surg. 2020 Jun;44(6):1824-1834. doi: 10.1007/s00268-020-05400-w.
The goal of our study was to evaluate the differences in care and clinical outcomes of patients with chest trauma between two hospitals, including one public trauma center (Pu-TC) and one private trauma center (Pri-TC).
Patients with thoracic trauma admitted from January 2012 to December 2018 at two level I trauma centers (Pu-TC: Hospital Universitario del Valle, Pri-TC: Fundación Valle del Lili) in Cali, Colombia, were included. Multivariable logistic regression was used to assess for differences in in-hospital mortality, adjusting for relevant demographic and clinical characteristics.
A total of 482 patients were identified; 300 (62.2%) at the Pri-TC and 182 (37.8%) at the Pu-TC. Median age was 27 years (IQR 21-36) and median Injury Severity Score was 25 (IQR 16-26). 456 patients (94.6%) were male, and the majority had penetrating trauma [total 465 (96.5%); Pri-TC 287 (95.7%), Pu-TC 179 (98.4%), p 0.08]. All patients arrived at the emergency room with unstable hemodynamics. There were no statistically significant differences in post-operative complications, including retained hemothorax [Pri-TC 19 vs. Pu-TC 18], pneumonia [Pri-TC 14 vs. Pu-TC 14], empyema [Pri-TC 13 vs. Pu-TC 13] and mediastinitis [Pri-TC 6 vs. Pu-TC 2]. Logistic regression did, however, show a higher odds of mortality when patients were treated at the Pu-TC [OR 2.27 (95% CI 1.34-3.87, p < 0.001].
Our study found significant statistical differences in clinical outcomes between patients treated at a Pu-TC and Pri-TC. The results are intended to stimulate discussions to better understand reasons for outcome variability and ways to reduce it.
我们的研究目的是评估两家医院（一家公立创伤中心[Pu-TC]和一家私立创伤中心[Pri-TC]）的胸部创伤患者的护理和临床结局差异。
纳入 2012 年 1 月至 2018 年 12 月在哥伦比亚卡利的两家一级创伤中心（Pu-TC：Universitario del Valle 医院；Pri-TC：Fundación Valle del Lili）收治的胸部创伤患者。采用多变量逻辑回归评估院内死亡率的差异，并调整相关人口统计学和临床特征。
共纳入 482 例患者，其中 300 例（62.2%）在 Pri-TC，182 例（37.8%）在 Pu-TC。中位年龄为 27 岁（IQR 21-36），中位损伤严重度评分 25（IQR 16-26）。456 例（94.6%）为男性，多数为穿透性创伤[总 465 例（96.5%）；Pri-TC 287 例（95.7%），Pu-TC 179 例（98.4%），p=0.08]。所有患者到达急诊室时均存在不稳定的血流动力学。术后并发症，包括血胸残留[Pri-TC 19 例 vs. Pu-TC 18 例]、肺炎[Pri-TC 14 例 vs. Pu-TC 14 例]、脓胸[Pri-TC 13 例 vs. Pu-TC 13 例]和纵隔炎[Pri-TC 6 例 vs. Pu-TC 2 例]，两组间无统计学差异。然而，逻辑回归显示 Pu-TC 治疗的患者死亡的可能性更高[OR 2.27（95%CI 1.34-3.87，p<0.001]。
本研究发现 Pu-TC 和 Pri-TC 治疗的患者在临床结局方面存在显著的统计学差异。结果旨在激发讨论，以更好地了解结果变异性的原因和降低变异性的方法。
