Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Laryngoscope. 2021 Apr;131(4):E1109-E1116. doi: 10.1002/lary.29088. Epub 2020 Sep 7.
OBJECTIVES/HYPOTHESIS: Despite being common, neck injuries have received relatively little attention for important quality of care metrics. This study sought to determine the association between blunt and penetrating neck injuries on mortality and length of stay, and to identify additional patient and hospital-level characteristics that impact these outcomes.
Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program database.
Adult patients (≥18) who sustained traumatic injuries involving the soft tissues of the neck between 2012 and 2016 were eligible. Multiple imputation was used to account for missing data. Logistic regression and negative binomial models were used to analyze 1) in-hospital mortality and 2) length of stay respectively while adjusting for potential confounders and accounting for clustering at the hospital level.
In a cohort of 20,285 patients, the crude mortality rate was lower in those sustaining blunt neck injuries compared to penetrating injuries (4.9% vs. 6.0%, P < .01), while length of hospital stay was similar (median 9.9 vs. 10.2, P = 0.06). In adjusted analysis, blunt neck injuries were associated with a reduced odds of mortality during hospital admission (odds ratio: 0.66, 95% confidence intervals [0.564, 0.788]), as well as significant reductions in length of stay (rate ratio: 0.92, 95% confidence intervals [0.880, 0.954]).
Blunt neck injuries are associated with lower mortality and length of stay compared to penetrating injuries. Areas of future study have been identified, including elucidation of processes of care in specific organs of injury.
Level 3 Laryngoscope, 131:E1109-E1116, 2021.
目的/假设：尽管颈部损伤很常见，但在重要的护理质量指标方面，人们对其关注相对较少。本研究旨在确定钝性和穿透性颈部损伤与死亡率和住院时间的关系，并确定影响这些结果的其他患者和医院特征。
利用美国外科医师学会创伤质量改进计划数据库进行回顾性队列研究。
2012 年至 2016 年期间，符合纳入标准的成人（≥18 岁）患者发生涉及颈部软组织的创伤性损伤。采用多重插补法处理缺失数据。采用逻辑回归和负二项回归模型分别分析 1）院内死亡率和 2）住院时间，同时调整潜在混杂因素，并考虑医院水平的聚类。
在 20285 例患者的队列中，与穿透性颈部损伤相比，钝性颈部损伤的粗死亡率较低（4.9%比 6.0%，P<.01），而住院时间相似（中位数 9.9 比 10.2，P=0.06）。在调整分析中，与穿透性颈部损伤相比，钝性颈部损伤与住院期间死亡的可能性降低相关（比值比：0.66，95%置信区间[0.564，0.788]），同时住院时间显著缩短（比率比：0.92，95%置信区间[0.880，0.954]）。
与穿透性颈部损伤相比，钝性颈部损伤的死亡率和住院时间较低。已经确定了未来研究的领域，包括阐明特定损伤器官的护理过程。
3 级喉镜，131：E1109-E1116，2021 年。
