Plurad David, Geesman Glenn, Sheets Nicholas, Chawla-Kondal Bhani, Mahmoud Ahmed
Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA.
General Surgery, Riverside Community Hospital, Riverside, USA.
Cureus. 2021 Apr 13;13(4):e14462. doi: 10.7759/cureus.14462.
Background Studies show increased early and overall mortality at level II compared to level I trauma centers in hemodynamically unstable patients. We hypothesize there is no mortality difference between level I and level II centers applying more contemporary data. Study design Utilizing the 2017 Trauma Quality Program Participant Use File (TQP-PUF), we identified adult patients (age >14 years) who presented to an American College of Surgeons (ACS) verified level I or II center with hypotension (systolic blood pressure [SBP] < 90 mmHg). Logistic regression was performed to identify adjusted associations with mortality. Results A total of 7,264 patients met the inclusion criteria, of whom most were males (4,924 [67.8%]) with blunt trauma (5,924 [81.6%]) being predominated. Mean admission SBP was 73.2 (±13.0) mmHg. There were 1,097 (15.1%) deaths. Level I admissions (4,931 (67.9%]) were more likely male (3,389 [68.7%] vs. 1,535 [65.8]; p=0.012), non-white (3,119 [63.3%] vs. 1,664 [71.3%]; p<0.001), a victim of penetrating trauma (933 [18.9%] vs. 385 [16.5%]; p=0.015), and more severely injured (mean Injury Severity Score: 19.3 [±15] vs. 16.7 [±13.7]; p<0.001). Level II admissions (2,333 [32.1%]) were older (46.8 [±18.5] vs. 50.3 [±20.1] years; p<0.001) with more co-morbidities (mean Charlson Comorbidity Index: 1.43 [±2] vs. 1.77 [±2.2]; p<0.001). Adjusted mortality between level I and II admissions was similar (766 [15.5%] vs. 331 [14.2%]; p=0.918). Early hourly mortality also did not differ. Conclusion There is no overall or hourly mortality discrepancy between ACS-verified level I and II centers for patients presenting with hypotension. This potentially relates to the use of more contemporary data gathered after implementation of updated verification requirements.
研究表明，与I级创伤中心相比，血流动力学不稳定患者在II级创伤中心的早期死亡率和总死亡率更高。我们推测，应用更多当代数据时，I级和II级创伤中心之间不存在死亡率差异。
利用2017年创伤质量项目参与者使用文件（TQP-PUF），我们确定了成年患者（年龄>14岁），这些患者因低血压（收缩压[SBP]<90 mmHg）就诊于美国外科医师学会（ACS）认证的I级或II级创伤中心。进行逻辑回归以确定与死亡率的校正关联。
共有7264例患者符合纳入标准，其中大多数为男性（4924例[67.8%]），以钝性创伤为主（5924例[81.6%]）。平均入院收缩压为73.2（±13.0）mmHg。有1097例（15.1%）死亡。I级创伤中心的入院患者（4931例[67.9%]）更可能为男性（3389例[68.7%]对1535例[65.8%]；p=0.012）、非白人（3119例[63.3%]对1664例[71.3%]；p<0.001）、穿透性创伤受害者（933例[18.9%]对385例[16.5%]；p=0.015），且受伤更严重（平均损伤严重度评分：19.3[±15]对16.7[±13.7]；p<0.001）。II级创伤中心的入院患者（2333例[32.1%]）年龄更大（46.8[±18.5]岁对50.3[±20.1]岁；p<0.001），合并症更多（平均查尔森合并症指数：1.43[±2]对1.77[±2.2]；p<0.001）。I级和II级创伤中心入院患者的校正死亡率相似（766例[15.5%]对331例[14.2%]；p=0.918）。早期每小时死亡率也无差异。
对于出现低血压的患者，ACS认证的I级和II级创伤中心之间不存在总体或每小时死亡率差异。这可能与实施更新的认证要求后收集的更多当代数据的使用有关。
