Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):4131-4141. doi: 10.1007/s00068-022-01950-x. Epub 2022 Mar 23.
The extent to which patients with laryngeal trauma undergo investigation and intervention is largely unknown. The objective of this study was to therefore determine the association between hospital volume and processes of care in patients sustaining laryngeal trauma.
This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥ 18) who sustained traumatic laryngeal injuries between 2012 and 2016 were eligible. The exposure of interest was average annual laryngeal trauma volume categorized into quartiles. The primary and secondary outcomes of interest were the performances of diagnostic and therapeutic laryngeal procedures respectively. Multivariable logistic regression under a generalized estimating equations approach was utilized.
In total, 1164 patients were included. The average number of laryngeal trauma cases per hospital ranged from 0.2 to 7.2 per year. Diagnostic procedures were performed in 31% of patients and therapeutic in 19%. In patients with severe laryngeal injuries, diagnostic procedures were performed on a higher proportion of patients at high volume centers than low volume centers (46% vs 25%). In adjusted analysis, volume was not associated with the performance of diagnostic procedures. Patients treated at centers in the second (OR 1.94 [95% CI 1.29-2.90]) and third (OR 1.67 [95% CI 1.08-2.57]) volume quartiles had higher odds of undergoing a therapeutic procedure compared to the lowest volume quartile.
Hospital volume may be associated with processes of care in laryngeal trauma. Additional research is required to investigate how these findings relate to patient and health system outcomes.
喉外伤患者接受检查和干预的程度在很大程度上尚不清楚。因此，本研究的目的是确定医院容量与喉外伤患者护理过程之间的关联。
这是一项回顾性队列研究，使用了美国外科医师学会创伤质量改进计划数据库。符合条件的患者为 2012 年至 2016 年间发生创伤性喉损伤的成年患者（≥18 岁）。本研究的暴露因素为按四分位数分类的平均每年喉外伤量。主要和次要结局分别为诊断和治疗性喉操作的表现。采用广义估计方程方法进行多变量逻辑回归分析。
共纳入 1164 例患者。每家医院每年发生的喉外伤病例数平均为 0.2 至 7.2 例。31%的患者接受了诊断性操作，19%的患者接受了治疗性操作。在严重喉损伤患者中，高容量中心比低容量中心进行诊断性操作的患者比例更高（46%比 25%）。在调整分析中，容量与诊断性操作的执行无关。与最低容量四分位组相比，在第二（OR 1.94 [95%CI 1.29-2.90]）和第三（OR 1.67 [95%CI 1.08-2.57]）容量四分位组接受治疗性操作的患者更有可能。
医院容量可能与喉外伤的护理过程有关。需要进一步研究这些发现如何与患者和医疗系统结果相关。
