Toida Chiaki, Muguruma Takashi, Gakumazawa Masayasu, Shinohara Mafumi, Abe Takeru, Takeuchi Ichiro, Morimura Naoto
Department of Disaster Medical Management, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan.
J Clin Med. 2021 Apr 1;10(7):1422. doi: 10.3390/jcm10071422.
Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical parameters and outcomes per hospital between low- and high-volume hospitals. During the five-year study period, we enrolled 53,088 severely injured patients (Injury Severity Score, ≥16); 2889 (5.4%) were pediatric patients aged <18 years. Significant Spearman correlation analysis was observed between numbers of total patients and SIPP per hospital ( < 0.001), and the number of SIPP per hospital who underwent interhospital transportation and/or urgent treatment was correlated with the total number of severely injured patients per hospital. Actual in-hospital mortality, per hospital, of SIPP patients was significantly correlated with the total number patients per hospital ( < 0.001,). The total number of SIPP, requiring urgent treatment, was higher in the high-volume than in the low-volume hospital group. No significant differences in actual in-hospital morality ( = 0.246, 2.13 (0-8.33) vs. 0 (0-100)) and standardized mortality ratio (SMR) values ( = 0.244, 0.31 (0-0.79) vs. 0 (0-4.87)) were observed between the two groups; however, the 13 high-volume hospitals had an SMR of <1.0. Centralizing severely injured patients, regardless of age, to a higher volume hospital might contribute to survival benefits of SIPP.
需要建立适合儿童的适当创伤护理系统；因此，这项全国性回顾性研究评估了严重受伤患者的年度医院总量与严重受伤儿科患者（SIPP）的院内死亡率之间的相关性，并比较了低容量医院和高容量医院之间每家医院的临床参数和结局。在为期五年的研究期间，我们纳入了53088例严重受伤患者（损伤严重度评分≥16）；其中2889例（5.4%）为18岁以下的儿科患者。观察到每家医院的总患者数与SIPP之间存在显著的Spearman相关性（<0.001），并且每家医院接受院际转运和/或紧急治疗的SIPP数量与每家医院严重受伤患者的总数相关。SIPP患者每家医院的实际院内死亡率与每家医院的患者总数显著相关（<0.001）。高容量医院组中需要紧急治疗的SIPP总数高于低容量医院组。两组之间在实际院内死亡率（=0.246，2.13（0 - 8.33）对0（0 - 100））和标准化死亡率（SMR）值（=0.244，0.31（0 - 0.79）对0（0 - 4.87））方面未观察到显著差异；然而，13家高容量医院的SMR<1.0。将严重受伤患者，无论年龄大小，集中到容量更大的医院可能有助于SIPP患者的生存获益。
