From the Trauma Research Unit, Department of Surgery (J.C.V.D., C.R.L.V.D.D., C.A.S., E.M.M.V.L., M.H.J.V., D.D.H.), and Department of Public Health (C.A.S.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Trauma Acute Care Surg. 2020 Oct;89(4):801-812. doi: 10.1097/TA.0000000000002850.
With implementation of trauma systems, a level of trauma care classification was introduced. Use of such a system has been linked to significant improvements in survival and other outcomes.
The aim of this study was assessing the association between level of trauma care and fatal and nonfatal outcome measures for general and major trauma (MT) populations.
A systematic literature search was conducted using six electronic databases up to December 18, 2019. Studies comparing mortality or nonfatal outcomes between different levels of trauma care in general and MT populations (preferably Injury Severity Score of >15) were included. Two independent reviewers performed selection of relevant studies, data extraction, and a quality assessment of included articles. With a random-effects meta-analysis, adjusted and unadjusted pooled effect sizes were calculated for level I versus non-level I trauma centers.
Twenty-two studies were included. Quality of the included studies was good; however, adjustment for comorbidity (32%) and interhospital transfer (38%) was performed less frequently. Nine (60%) of the 15 studies analyzing in-hospital mortality in general trauma populations reported a survival benefit for level I trauma centers. Level I trauma centers were not associated with higher mortality than non-level I trauma centers (adjusted odd ratio, 0.97; 95% confidence interval, 0.61-1.52). Of the 11 studies reporting in-hospital mortality in MT populations, 10 (91%) reported a survival benefit for level I trauma centers. Level I trauma centers were associated with lower mortality than non-level I trauma centers (adjusted odd ratio, 0.77; 95% confidence interval, 0.69-0.87).
The association between level of trauma care and in-hospital mortality is evident for MT populations; however, this does not hold for general trauma populations. Level I trauma centers produce improved survival in MT populations. This association could not be proven for nonfatal outcomes in general and MT populations because of inconsistencies in the body of evidence.
Systematic review and meta-analysis, level III.
随着创伤系统的实施，引入了创伤护理分类级别。此类系统的使用与生存率和其他结果的显著改善相关。
本研究旨在评估创伤护理级别与一般和重大创伤（MT）人群的致命和非致命结局指标之间的关联。
使用六个电子数据库进行了系统文献检索，检索截至 2019 年 12 月 18 日。纳入了比较一般和 MT 人群（最好是损伤严重程度评分> 15）不同创伤护理级别之间死亡率或非致命结局的研究。两名独立审查员进行了相关研究的选择、数据提取以及纳入文章的质量评估。使用随机效应荟萃分析，计算了 I 级与非 I 级创伤中心之间的调整和未调整的合并效应大小。
共纳入 22 项研究。纳入研究的质量良好；然而，调整合并症（32%）和院内转院（38%）的频率较低。在分析一般创伤人群院内死亡率的 15 项研究中，有 9 项（60%）报告 I 级创伤中心具有生存优势。I 级创伤中心的死亡率不比非 I 级创伤中心高（调整后的优势比，0.97；95%置信区间，0.61-1.52）。在报告 MT 人群院内死亡率的 11 项研究中，有 10 项（91%）报告 I 级创伤中心具有生存优势。I 级创伤中心的死亡率低于非 I 级创伤中心（调整后的优势比，0.77；95%置信区间，0.69-0.87）。
创伤护理级别与 MT 人群院内死亡率之间存在关联；然而，这在一般创伤人群中并不成立。I 级创伤中心可提高 MT 人群的生存率。由于证据不一致，无法证明一般和 MT 人群的非致命结局存在这种关联。
系统评价和荟萃分析，III 级。
