非创伤中心以及一级、二级和三级创伤中心在肋骨骨折治疗方面的异质性。
Heterogeneity in managing rib fractures across non-trauma and level I, II, and III trauma centers.
作者信息
Choi Jeff, Kaghazchi Aydin, Dickerson Katherine L, Tennakoon Lakshika, Spain David A, Forrester Joseph D
机构信息
Division of General Surgery, Department of Surgery, Stanford University, USA; Department of Epidemiology and Population Health, Stanford University, USA; Surgeons Writing About Trauma, Stanford University, USA.
Department of Epidemiology and Population Health, Stanford University, USA; Surgeons Writing About Trauma, Stanford University, USA.
出版信息
Am J Surg. 2021 Oct;222(4):849-854. doi: 10.1016/j.amjsurg.2021.02.013. Epub 2021 Feb 16.
BACKGROUND
We aimed to elucidate management patterns and outcomes of high-risk patients with rib fractures (elderly or flail chest) across non-trauma and trauma centers. We hypothesized highest-capacity (level I) centers would have best outcomes for high-risk patients.
METHODS
We queried the 2016 National Emergency Department Sample to identify adults presenting with rib fractures. Multivariable regression assessed ED and inpatient events across non-trauma and level III/II/I trauma centers.
RESULTS
Among 504,085 rib fracture encounters, 46% presented to non-trauma centers. Elderly patients with multiple rib fractures had stepwise increase in inpatient admission odds and stepwise decrease in pneumonia odds at higher-capacity trauma centers compared to non-trauma centers. Among patients with flail chest, odds of undergoing surgical stabilization (SSRF) increased at trauma centers. Undergoing SSRF was associated with reduced mortality but remained underutilized.
CONCLUSION
Half of patients with rib fractures present to non-trauma centers. Nationwide care-optimization for high-risk patients requires further effort.
背景
我们旨在阐明非创伤中心和创伤中心对肋骨骨折高危患者（老年人或连枷胸）的管理模式及治疗结果。我们假设最高能力（一级）中心对高危患者的治疗结果最佳。
方法
我们查询了2016年国家急诊科样本，以确定出现肋骨骨折的成年人。多变量回归分析评估了非创伤中心以及三级/二级/一级创伤中心的急诊科和住院事件。
结果
在504,085例肋骨骨折病例中，46%就诊于非创伤中心。与非创伤中心相比，在能力更高的创伤中心，多处肋骨骨折的老年患者住院入院几率逐步增加，肺炎几率逐步降低。在连枷胸患者中，创伤中心进行手术固定（SSRF）的几率增加。进行SSRF与降低死亡率相关，但仍未得到充分利用。
结论
一半的肋骨骨折患者就诊于非创伤中心。全国范围内对高危患者的护理优化仍需进一步努力。
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