From the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Que. (Batomen, Carabali); the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Moore) and the Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de recherche du CHU de Québec - Université Laval, Québec, Que. (Moore, Tardif); the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md. (Champion); and the Institute for Health and Social Policy, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Que. (Nandi).
Can J Surg. 2021 Jan 15;64(1):E25-E38. doi: 10.1503/cjs.016219.
There is a growing trend toward verification of trauma centres, but its impact remains unclear. This systematic review aimed to synthesize available evidence on the effectiveness of trauma centre verification.
We conducted a systematic search of the CINAHL, Embase, HealthStar, MEDLINE and ProQuest databases, as well as the websites of key injury organizations for grey literature, from inception to June 2019, without language restrictions. Our population consisted of injured patients treated at trauma centres. The intervention was trauma centre verification. Comparison groups comprised nonverified trauma centres, or the same centre before it was first verified or re-verified. The primary outcome was in-hospital mortality; secondary outcomes included adverse events, resource use and processes of care. We computed pooled summary estimates using random-effects meta-analysis.
Of 5125 citations identified, 29, all conducted in the United States, satisfied our inclusion criteria. Mortality was the most frequently investigated outcome (n = 20), followed by processes of care (n = 12), resource use (n = 12) and adverse events (n = 7). The risk of bias was serious to critical in 22 studies. We observed an imprecise association between verification and decreased mortality (relative risk 0.74, 95% confidence interval 0.52 to 1.06) in severely injured patients.
Our review showed mixed and inconsistent associations between verification and processes of care or patient outcomes. The validity of the published literature is limited by the lack of robust controls, as well as any evidence from outside the US, which precludes extrapolation to other health care jurisdictions. Quasiexperimental studies are needed to assess the impact of trauma centre verification.
PROSPERO no. CRD42018107083.
创伤中心的验证工作呈增长趋势，但目前其影响仍不明确。本系统评价旨在综合现有关于创伤中心验证有效性的证据。
我们系统地检索了 CINAHL、Embase、HealthStar、MEDLINE 和 ProQuest 数据库以及关键损伤组织的网站，以获取截至 2019 年 6 月的灰色文献，无语言限制。我们的研究人群为在创伤中心接受治疗的受伤患者。干预措施为创伤中心的验证。对照组为未经过验证的创伤中心，或者首次验证或重新验证之前的同一中心。主要结局为院内死亡率；次要结局包括不良事件、资源利用和治疗过程。我们使用随机效应荟萃分析计算汇总估计值。
在 5125 条引文中有 29 条符合纳入标准，均来自美国。死亡率是最常被研究的结局（n=20），其次是治疗过程（n=12）、资源利用（n=12）和不良事件（n=7）。22 项研究的偏倚风险为严重至关键。我们观察到在严重受伤患者中，验证与死亡率降低之间存在不精确的关联（相对风险 0.74，95%置信区间 0.52 至 1.06）。
本综述表明，验证与治疗过程或患者结局之间的关联存在差异且不一致。发表文献的有效性受到缺乏稳健对照以及来自美国以外的任何证据的限制，这使得无法将其推断至其他卫生保健司法管辖区。需要进行准实验研究来评估创伤中心验证的影响。
PROSPERO 编号 CRD42018107083。
