University Hospital of Derby and Burton (Queens Hospital), Belvedere Road, Burton on Trent, DE13 0RB, United Kingdom.
Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Gorway Road, Walsall, WS1 3BD, United Kingdom.
Injury. 2020 Oct;51(10):2209-2218. doi: 10.1016/j.injury.2020.07.014. Epub 2020 Jul 9.
Major trauma centres have improved morbidity and mortality for moderate and severely injured patients. Less injured patients may be treated in facilities less resourced for trauma care. In these units, understanding the variations in injury presentation and treatment over time allows service delivery to be tailored to demand. This study set out to describe seasonal variations in trauma over a 10-year period at a level III trauma unit.
Patient demographics, admission frequency, site of injury, season of admission, management, complications, onward transfers, and length of stay were extracted on consecutive patients admitted with traumatic injuries between January 2009 and December 2018 and recorded on a prospectively maintained database. Analysis was undertaken to determine if there were reproducible patterns in trauma presentation across seasons, based on the patient's age and gender, type of injury, management and length of stay.
There were 13,007 'first admissions' over 10 years, with a mean (SD) age of 55.6 (27.7) years. Admissions were higher in summer (27%) and lower in winter (23.6%) and patients were on average younger in the summer (52.8 years) and older in winter (59.2 years). The proportion of female and male patients remained relatively constant across seasons (CV=6% and 8%, respectively). There was seasonal variation in the incidence of forearm (36%) elbow (19%), and multi-sites injuries (17%) compared with hip and wrist injuries (CV=5% for both). A lower proportion of patients underwent operations in summer (72%) compared with other seasons with winter having the highest at 77%. More patients aged less than 60 years stayed in hospital during winter than summer (13.2% vs. 11.6-12.4%) although often for a day. Patients aged 60 years stayed longer in spring and winter.
The results of this study demonstrate trends in the admission and management of trauma patients to a level III trauma unit. Some of the patterns in admission, treatment and length of stay had not been identified previously. The results can be used to enhance patient care and minimise health care costs by reducing unwarranted variations and enabling service delivery to match the demand in all trauma units.
大型创伤中心改善了中度和重度受伤患者的发病率和死亡率。 受伤较轻的患者可能在资源较少的创伤治疗机构接受治疗。 在这些单位中，了解随时间推移的伤害表现和治疗的变化可以使服务交付适应需求。 本研究旨在描述三级创伤单位 10 年期间的季节性创伤变化。
在 2009 年 1 月至 2018 年 12 月期间，连续收治外伤性损伤患者，并前瞻性地维护数据库，提取患者人口统计学、入院频率、损伤部位、入院季节、管理、并发症、转院和住院时间。 分析是为了确定是否根据患者的年龄和性别、损伤类型、管理和住院时间在创伤表现上存在可重复的模式。
10 年间共收治“首次入院”患者 13007 例，平均（SD）年龄为 55.6（27.7）岁。 夏季（27%）入院率较高，冬季（23.6%）较低，夏季患者平均年龄较小（52.8 岁），冬季较大（59.2 岁）。 男女患者的比例在整个季节相对保持不变（CV=6%和 8%）。 与髋部和腕部损伤（CV 均为 5%）相比，前臂（36%）肘部（19%）和多部位损伤（17%）的发生率存在季节性变化。 夏季手术比例较低（72%），冬季手术比例最高（77%）。 冬季年龄小于 60 岁的患者住院时间多于夏季（13.2%比 11.6-12.4%），尽管通常只有一天。 60 岁以上的患者在春季和冬季停留时间更长。
本研究结果表明，三级创伤单位创伤患者入院和管理的趋势。 一些入院、治疗和住院时间的模式以前没有被发现。 这些结果可用于通过减少不必要的变化并使服务交付与所有创伤单位的需求相匹配来增强患者护理并降低医疗保健成本。
