从何处入手？加拿大创伤性损伤的预防重点评分。
Where to start? Injury prevention priority scores for traumatic injuries in Canada.
机构信息
From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Jessula); the Section of Pediatric Surgery, Department of Surgery, University of Calgary, Calgary, Alta (Yanchar); the Division of Pediatric General and Thoracic Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, NS (Romao); Trauma Nova Scotia, Halifax, NS (Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge)
From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Jessula); the Section of Pediatric Surgery, Department of Surgery, University of Calgary, Calgary, Alta (Yanchar); the Division of Pediatric General and Thoracic Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, NS (Romao); Trauma Nova Scotia, Halifax, NS (Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge).
出版信息
Can J Surg. 2022 May 17;65(3):E326-E334. doi: 10.1503/cjs.021420. Print 2022 May-Jun.
BACKGROUND
Given limited resources for injury prevention, it is essential to determine which mechanisms of injury to target to provide the most benefit to the largest proportion of the population. We developed objective, evidence-based injury prevention priority scores (IPPSs) for the Canadian population across 4 prevention perspectives: mortality, injury severity, resource use and societal cost.
METHODS
We performed a retrospective cohort study of all injuries in Canada from 2009/10 to 2013/14. Hospital admissions were obtained from the Discharge Abstract Database, and deaths from the Statistics Canada Canadian Vital Statistics Death Database. For each mechanism of injury, we calculated an IPPS as a balanced measure of injury frequency and 1) mortality rate, 2) median 1 - ICISS (Injury Severity Score derived from the , enhanced Canadian version), 3) median cost per hospital stay or 4) median potential years of life lost (PYLL), providing a ranking of mechanisms of injury in priority order. The IPPS by definition has a mean of 50 and a standard deviation of 10. The higher the IPPS, the higher the priority for injury prevention.
RESULTS
A total of 694 535 injuries were identified over the study period. The most frequent mechanism of injury was falls (391 068 [56.3%]). The overall mortality rate was 0.09 deaths/injured person, the median 1 - ICISS was 0.017, the median cost was $5217, and the median PYLL was 0. The mechanisms with the 3 highest IPPSs were falls (75), self-harm (67) and drowning (66) for mortality; falls (77), drowning (70) and suffocation (61) for severity; falls (80), suffocation (63) and fire (60) for resource use; and falls (72), assault (62), and firearms and legal interventions (59 in both cases) for societal cost.
CONCLUSION
This study produced IPPSs for traumatic injuries in Canada that provide objective and quantifiable methods for identifying mechanisms of injury to target for specific prevention initiatives. Preventing falls would provide the most benefit to the largest proportion of Canadians and should be prioritized in injury-prevention policy.
背景
鉴于可用于预防伤害的资源有限，因此确定应针对哪些伤害机制进行干预，以便使最大比例的人群受益最多，这一点至关重要。我们针对加拿大人口，从四个预防角度（死亡率、伤害严重程度、资源利用和社会成本）制定了客观的、基于证据的伤害预防优先评分（IPPS）。
方法
我们对 2009/10 年至 2013/14 年加拿大的所有伤害进行了回顾性队列研究。从出院摘要数据库获取住院治疗信息，从加拿大统计死亡数据库获取死亡信息。对于每种伤害机制，我们计算了 IPPS，该评分是伤害频率的均衡指标，具体计算方法如下：1）死亡率；2）中位数 1-ICISS（衍生自加拿大改良版的伤害严重度评分）；3）每次住院治疗的平均费用；4）平均潜在寿命损失年数（PYLL）。通过以上四个方面为每种伤害机制进行了优先排序。根据定义，IPPS 的平均值为 50，标准差为 10。IPPS 越高，伤害预防的优先级越高。
结果
研究期间共确定了 694535 例伤害。最常见的伤害机制是跌倒（391068 [56.3%]）。总体死亡率为每受伤 0.09 人死亡，中位数 1-ICISS 为 0.017，平均费用为 5217 美元，平均 PYLL 为 0。死亡率最高的三个 IPPS 分别为跌倒（75）、自残（67）和溺水（66）；严重程度最高的三个 IPPS 分别为跌倒（77）、溺水（70）和窒息（61）；资源利用最高的三个 IPPS 分别为跌倒（80）、窒息（63）和火灾（60）；社会成本最高的三个 IPPS 分别为跌倒（72）、攻击（62）和枪支与合法干预（两者均为 59）。
结论
本研究制定了加拿大创伤性伤害的 IPPS，为确定特定预防措施的目标伤害机制提供了客观、可量化的方法。预防跌倒可使最大比例的加拿大人受益最多，因此应在伤害预防政策中优先考虑预防跌倒。
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