更多更好吗？全州范围内增加创伤中心是否能降低与伤害相关的死亡率？
Is more better? Do statewide increases in trauma centers reduce injury-related mortality?
机构信息
From the Department of Surgery (E.I.T., V.P.H., E.S.T., E.T.C., J.A.C.), MetroHealth Medical Center, and Department of Population and Quantitative Health Sciences (V.P.H., C.N., J.C.), Case Western Reserve University, Cleveland, Ohio.
出版信息
J Trauma Acute Care Surg. 2021 Jul 1;91(1):171-177. doi: 10.1097/TA.0000000000003178.
OBJECTIVES
Trauma centers are inconsistently distributed throughout the United States. It is unclear if new trauma centers improve care and decrease mortality. We tested the hypothesis that increases in trauma centers are associated with decreases in injury-related mortality (IRM) at the state level.
METHODS
We used data from the American Trauma Society to geolocate every state-designated or American College of Surgeons-verified trauma center in all 50 states and the District of Columbia from 2014 to 2018. These data were merged with publicly available IRM data from the Centers for Disease Control and Prevention. We used geographic information systems methods to map and study the relationships between trauma center locations and state-level IRM over time. Regression analysis, accounting for state-level fixed effects, was used to calculate the effect of total statewide number of trauma center on IRM and year-to-year changes in statewide trauma center with the IRM (shown as deaths per additional trauma center per 100,000 population, p value).
RESULTS
Nationwide between 2014 and 2018, the number of trauma center increased from 2,039 to 2,153. Injury-related mortality also increased over time. There was notable interstate variation, from 1 to 284 trauma centers. Four patterns in statewide trauma center changes emerged: static (12), increased (29), decreased (5), or variable (4). Of states with trauma center increases, 26 (90%) had increased IRM between 2014 and 2017, while the remaining 3 saw a decline. Regression analysis demonstrated that having more trauma centers in a state was associated with a significantly higher IRM rate (0.38, p = 0.03); adding new trauma centers was not associated with changes in IRM (0.02, p = 0.8).
CONCLUSION
Having more trauma centers and increasing the number of trauma center within a state are not associated with decreases in state-level IRM. In this case, more is not better. However, more work is needed to identify the optimal number and location of trauma centers to improve IRM.
LEVEL OF EVIDENCE
Epidemiologic, level III; Care management, level III.
目的
创伤中心在美国的分布不尽相同。新增创伤中心是否能改善救治效果、降低死亡率尚不清楚。本研究旨在验证以下假设，即在州层面上，新增创伤中心与伤害相关死亡率（IRM）的降低相关。
方法
我们使用美国创伤协会的数据，对 2014 年至 2018 年全美 50 个州和哥伦比亚特区的每一个州指定或美国外科医师学院认证的创伤中心进行地理定位。这些数据与美国疾病控制与预防中心提供的公开 IRM 数据进行了合并。我们使用地理信息系统方法绘制并研究了创伤中心位置与随时间推移的州级 IRM 之间的关系。我们使用回归分析，考虑了州级固定效应，计算了创伤中心总数对 IRM 的影响以及每年创伤中心数量变化对 IRM 的影响（表现为每增加 10 万人口中的 1 个创伤中心导致的死亡人数，p 值）。
结果
2014 年至 2018 年期间，全美创伤中心的数量从 2039 个增加到了 2153 个。IRM 也随时间推移而增加。各州之间的差异显著，从 1 个到 284 个创伤中心不等。全州范围内创伤中心变化呈现出 4 种模式：稳定（12 个）、增加（29 个）、减少（5 个）或多变（4 个）。在创伤中心增加的州中，26 个（90%）州在 2014 年至 2017 年间 IRM 增加，而其余 3 个州则出现下降。回归分析表明，一个州的创伤中心越多，其 IRM 率越高（0.38，p = 0.03）；新增创伤中心与 IRM 变化无关（0.02，p = 0.8）。
结论
拥有更多的创伤中心以及增加州内创伤中心的数量与州级 IRM 的降低无关。在这种情况下，更多并不意味着更好。然而，需要做更多的工作来确定最佳数量和位置的创伤中心，以改善 IRM。
证据水平
流行病学，III 级；护理管理，III 级。
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