Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
J Emerg Med. 2020 Mar;58(3):398-406. doi: 10.1016/j.jemermed.2019.12.029. Epub 2020 Feb 15.
Motor vehicular transport (MVT) is a leading cause of injuries globally. Health care regionalization aims at improving patients' outcomes.
This study examines the association between trauma center designation levels in the United States and survival of patients with MVT-related injuries.
We used the National Trauma Data Bank 2015 dataset for this retrospective study. We conducted descriptive and bivariate analyses. This was followed by a multivariate analysis to assess the association between trauma center level and survival to hospital discharge.
One hundred sixty-eight thousand five hundred twenty-four patients were included in this study. The mean age was 39.9 years (±19.5 years) with a male predominance (63.8%). Most patients were taken to level I (55.7%) and level II (35.9%) centers. The overall survival of patients with MVT injuries was 95.3%. Involved patients were occupant (64.8%), motorcyclist (17.3%), and pedestrian (12.7%). After adjusting for confounders, patients sustaining MVT injuries who were taken to level II and III trauma centers were less likely survive compared with those taken to level I centers (odds ratio = 0.89 [95% confidence interval 0.81-0.97] and odds ratio = 0.70 [95% confidence interval 0.59-0.82], respectively).
In this study, we identified a survival benefit for patients with MVT injuries when treated at level I compared with level II and III centers. These findings provide additional evidence for the benefit of health care regionalization in the form of trauma center level designation.
机动车运输（MVT）是全球受伤的主要原因。医疗区域化旨在改善患者的预后。
本研究调查了美国创伤中心指定级别与 MVT 相关损伤患者生存之间的关联。
我们使用了 2015 年国家创伤数据库进行这项回顾性研究。我们进行了描述性和双变量分析。接着进行了多变量分析，以评估创伤中心级别与住院期间存活率之间的关联。
本研究共纳入 168524 例患者。平均年龄为 39.9±19.5 岁，男性居多（63.8%）。大多数患者被送往 I 级（55.7%）和 II 级（35.9%）中心。MVT 损伤患者的总体存活率为 95.3%。涉及的患者为乘客（64.8%）、摩托车手（17.3%）和行人（12.7%）。调整混杂因素后，与送往 I 级中心的患者相比，送往 II 级和 III 级创伤中心的 MVT 损伤患者存活的可能性较低（比值比=0.89[95%置信区间 0.81-0.97]和比值比=0.70[95%置信区间 0.59-0.82]）。
在这项研究中，我们发现与送往 II 级和 III 级中心相比，送往 I 级中心的 MVT 损伤患者具有生存获益。这些发现为以创伤中心级别指定形式进行医疗区域化的益处提供了额外的证据。
