Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 8788University of California, CA, USA.
Department of Neurological Surgery, 189204University of California, CA, USA.
Am Surg. 2021 Dec;87(12):1972-1979. doi: 10.1177/0003134820983187. Epub 2020 Dec 30.
Traumatic brain injury (TBI) occurs in approximately 30% of trauma patients. Because neurosurgeons hold expertise in treating TBI, increased neurosurgical staffing may improve patient outcomes. We hypothesized that TBI patients treated at level I trauma centers (L1TCs) with ≥3 neurosurgeons have a decreased risk of mortality vs. those treated at L1TCs with <3 neurosurgeons.
The Trauma Quality Improvement Program database (2010-2016) was queried for patients ≥18 years with TBI. Patient characteristics and mortality were compared between ≥3 and <3 neurosurgeon-staffed L1TCs. A multivariable logistic regression analysis was used to identify risk factors associated with mortality.
Traumatic brain injury occurred in 243 438 patients with 5188 (2%) presenting to L1TCs with <3 neurosurgeons and 238 250 (98%) to L1TCs with ≥3 neurosurgeons. Median injury severity score (ISS) was similar between both groups (17, = .09). There were more Black (37% vs. 12%, < .001) and Hispanic (18% vs. 12%, < .001) patients in the <3 neurosurgeon group. Nearly 60% of L1TCs with <3 neurosurgeons are found in the South. Mortality was higher in the <3 vs. the ≥3 group (12% vs. 10%, < .001). Patients treated in the <3 neurosurgeon group had a higher risk for mortality than those treated in the ≥3 neurosurgeon group (odds ratio (OR) 1.13, 95% confidence intervals (CI) 1.01-1.26, = .028).
There exists a significant racial disparity in access to neurosurgeon staffing with additional disparities in outcomes based on staffing. Future efforts are needed to improve this chasm of care that exists for trauma patients of color.
创伤性脑损伤（TBI）约占创伤患者的 30%。由于神经外科医生在治疗 TBI 方面具有专业知识，增加神经外科人员配备可能会改善患者的预后。我们假设，在接受≥3 名神经外科医生治疗的 I 级创伤中心（L1TC）治疗的 TBI 患者的死亡率低于在接受<3 名神经外科医生治疗的 L1TC 治疗的患者。
从 2010 年至 2016 年的创伤质量改进计划数据库中查询了≥18 岁的 TBI 患者。比较了≥3 名和<3 名神经外科医生配备的 L1TC 患者的患者特征和死亡率。采用多变量逻辑回归分析确定与死亡率相关的危险因素。
共有 243438 名 TBI 患者，其中 5188 名（2%）在<3 名神经外科医生配备的 L1TC 就诊，238250 名（98%）在≥3 名神经外科医生配备的 L1TC 就诊。两组患者的中位损伤严重程度评分（ISS）相似（17， =.09）。<3 名神经外科医生组中，黑人（37%比 12%， <.001）和西班牙裔（18%比 12%， <.001）患者更多。近 60%的<3 名神经外科医生配备的 L1TC 位于南部。<3 名神经外科医生组的死亡率高于≥3 名神经外科医生组（12%比 10%， <.001）。与≥3 名神经外科医生组相比，接受<3 名神经外科医生治疗的患者的死亡率更高（比值比（OR）为 1.13，95%置信区间（CI）为 1.01-1.26， =.028）。
神经外科人员配备方面存在明显的种族差异，而基于人员配备的结果也存在其他差异。需要进一步努力来缩小有色人种创伤患者存在的这种护理差距。
