创伤护理系统在不同发展阶段降低死亡率的效果：系统评价和荟萃分析。

BACKGROUND: Traumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development. METHOD: A systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI). RESULTS: A total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69-0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10-1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37-1.55]; p < 0.001). CONCLUSION: The present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019142842 .

背景：创伤仍然是导致死亡的主要原因，每年有超过 500 万人死亡。对于不同发展阶段的创伤救治系统在降低死亡率方面的比较效果，人们知之甚少。本研究的目的是综述文献并研究不同阶段创伤系统发展与死亡率之间的差异。

方法：对从 MEDLINE、EMBASE 和 CINAHL 检索到的同行评审的基于人群的研究进行系统综述。还通过文章参考文献、数据库搜索和作者列表确定了其他研究。纳入的文章为 2000 年至 2020 年间发表的英文文章。两名独立评审员进行了研究选择、数据提取和纳入研究的质量评估。结果以比值比（OR）及其 95%置信区间（CI）表示。

结果：共纳入 52 项研究，共计 1106431 例创伤性损伤患者进行定量分析。总死亡率为 6.77%（n=74930）。与创伤中心相比，患者在非创伤中心接受治疗时，死亡率的综合统计优势降低（OR 0.74 [95%CI 0.69-0.79]；p<0.001）。与创伤系统相比，患者在非创伤系统中接受治疗时，死亡率的优势增加（OR 1.17 [95%CI 1.10-1.24]；p<0.001）。与成熟系统相比，患者在实施/初始系统后接受治疗时，死亡率的优势显著更高（OR 1.46 [95%CI 1.37-1.55]；p<0.001）。

结论：本研究强调，创伤性损伤患者的生存率因接受治疗的创伤系统发展阶段而异。分析表明，随着创伤系统的引入，死亡率显著降低，随着系统的成熟，这一效果进一步增强。这些结果为努力实施目前尚无创伤系统的国家的创伤系统以及通过投资系统开发来增强现有系统提供了证据支持。

系统综述注册编号：PROSPERO CRD42019142842。