Elkbuli Adel, Dowd Brianna, Flores Rudy, Boneva Dessy, McKenney Mark
Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.
Department of Trauma, HCA-South Atlantic Division, Charleston, SC, USA.
J Emerg Trauma Shock. 2020 Jul-Sep;13(3):201-207. doi: 10.4103/JETS.JETS_49_19. Epub 2020 Sep 18.
Complication rates may be indicative of trauma center (TC) performance. The complication rates between Level 1 and 2 TCs at the national level are unknown. Our study aimed to determine the relationship between American College of Surgeons (ACS)-verified and state-designated TCs and complications.
This was a cohort review of the National Sample Program (NSP) from the National Trauma Data Bank, the world's largest validated trauma database. TCs were categorized by ACS or state Level 1 or 2. TCs not categorized as Level 1 or 2 were excluded. All 22 complications provided by the NSP were analyzed. Chi-squared analysis was used with statistical significance defined as < 0.05.
Of the 94 TCs in the NSP, 67 had ACS and 80 had state designations of Level 1 or 2. There were 38 ACS Level 1 TCs treating 87,340 patients and 29 ACS Level 2 TCs treating 35,763. There were 45 state Level 1 TCs treating 106,640 and 35 state Level 2 TCs treating 43,290. ACS Level 1 TCs had significantly higher complications compared to ACS Level 2 TCs (13.5% [11,776/87,340] vs. 10.1% [3,606/35,763], < 0.0001). In addition, state Level 1 TCs had significantly more complications compared to state Level 2 TCs (4.4% [4,681/106,640] vs. 1.6% [673/43,290], < 0.0001).
Both ACS and state Level 2 TCs had significantly lower complication rates than ACS and state Level 1 TCs. Further investigations should look for the source and impact of this difference.
并发症发生率可能表明创伤中心（TC）的绩效。国家层面一级和二级创伤中心之间的并发症发生率尚不清楚。我们的研究旨在确定美国外科医师学会（ACS）认证的创伤中心和州指定的创伤中心与并发症之间的关系。
这是一项对来自世界上最大的经过验证的创伤数据库——国家创伤数据库的国家样本计划（NSP）的队列回顾。创伤中心按美国外科医师学会或州一级或二级进行分类。未归类为一级或二级的创伤中心被排除。对国家样本计划提供的所有22种并发症进行了分析。采用卡方分析，统计学显著性定义为P<0.05。
在国家样本计划的94个创伤中心中，67个有美国外科医师学会认证，80个有州一级或二级指定。有38个美国外科医师学会一级创伤中心，治疗87340例患者；29个美国外科医师学会二级创伤中心，治疗35763例患者。有45个州一级创伤中心，治疗106640例患者；35个州二级创伤中心，治疗43290例患者。美国外科医师学会一级创伤中心的并发症发生率显著高于美国外科医师学会二级创伤中心（13.5%[11776/87340]对10.1%[3606/35763]，P<0.0001）。此外，州一级创伤中心的并发症显著多于州二级创伤中心（4.4%[4681/106640]对1.6%[673/43290]，P<0.0001）。
美国外科医师学会认证的二级创伤中心和州二级创伤中心的并发症发生率均显著低于美国外科医师学会认证的一级创伤中心和州一级创伤中心。进一步的研究应探寻这种差异的根源。
