From the Trauma Research Unit, Department of Surgery (J.C.V.D., L.A.R., E.M.M.V.L., M.H.J.V., C.A.S., D.D.H.), Trauma Center Southwest Netherlands (J.C.V.D., C.A.S., D.D.H.), Medical Library (W.M.B.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Trauma Acute Care Surg. 2023 Jun 1;94(6):877-892. doi: 10.1097/TA.0000000000003890. Epub 2023 Feb 2.
Trauma networks have multiple designated levels of trauma care. This classification parallels concentration of major trauma care, creating innovations and improving outcome measures.
The objective of this study is to assess associations of level of trauma care with patient outcomes for populations with specific severe injuries.
A systematic literature search was conducted using six electronic databases up to April 19, 2022 (PROSPERO CRD42022327576). Studies comparing fatal, nonfatal clinical, or functional outcomes across different levels of trauma care for trauma populations with specific severe injuries or injured body region (Abbreviated Injury Scale score ≥3) were included. Two independent reviewers included studies, extracted data, and assessed quality. Unadjusted and adjusted pooled effect sizes were calculated with random-effects meta-analysis comparing Level I and Level II trauma centers.
Thirty-five studies (1,100,888 patients) were included, of which 25 studies (n = 443,095) used for meta-analysis, suggesting a survival benefit for the severely injured admitted to a Level I trauma center compared with a Level II trauma center (adjusted odds ratio [OR], 1.15; 95% confidence interval [CI], 1.06-1.25). Adjusted subgroup analysis on in-hospital mortality was done for patients with traumatic brain injuries (OR, 1.23; 95% CI, 1.01-1.50) and hemodynamically unstable patients (OR, 1.09; 95% CI, 0.98-1.22). Hospital and intensive care unit length of stay resulted in an unadjusted mean difference of -1.63 (95% CI, -2.89 to -0.36) and -0.21 (95% CI, -1.04 to 0.61), respectively, discharged home resulted in an unadjusted OR of 0.92 (95% CI, 0.78-1.09).
Severely injured patients admitted to a Level I trauma center have a survival benefit. Nonfatal outcomes were indicative for a longer stay, more intensive care, and more frequently posthospital recovery trajectories after being admitted to top levels of trauma care. Trauma networks with designated levels of trauma care are beneficial to the multidisciplinary character of trauma care.
Systematic review and meta-analysis; Level III.
创伤网络有多个指定级别的创伤护理。这种分类与主要创伤护理的集中程度相平行，创造了创新并改善了结果衡量标准。
本研究的目的是评估特定严重损伤患者人群的创伤护理水平与患者结局之间的关联。
使用六个电子数据库进行了系统文献检索，检索时间截至 2022 年 4 月 19 日（PROSPERO CRD42022327576）。纳入了比较特定严重创伤或受伤身体部位（损伤严重度评分≥3）的创伤人群在不同创伤护理水平下的致命、非致命临床或功能结局的研究。两名独立审查员纳入研究、提取数据并评估质量。使用随机效应荟萃分析比较一级和二级创伤中心，计算未调整和调整后的汇总效应大小。
纳入了 35 项研究（1100888 名患者），其中 25 项研究（n=443095）用于荟萃分析，表明与二级创伤中心相比，严重受伤患者入住一级创伤中心有生存获益（调整后的优势比[OR]，1.15；95%置信区间[CI]，1.06-1.25）。对创伤性脑损伤患者（OR，1.23；95%CI，1.01-1.50）和血流动力学不稳定患者（OR，1.09；95%CI，0.98-1.22）进行了院内死亡率的调整亚组分析。住院和重症监护病房的住院时间分别产生了未调整的平均差值-1.63（95%CI，-2.89 至-0.36）和-0.21（95%CI，-1.04 至 0.61），出院回家的未调整 OR 为 0.92（95%CI，0.78-1.09）。
入住一级创伤中心的严重受伤患者有生存获益。非致命结局表明，在接受顶级创伤护理后，入住创伤护理指定级别更长的住院时间、更多的重症监护和更频繁的出院后恢复轨迹。具有指定创伤护理级别的创伤网络有利于创伤护理的多学科性质。
系统评价和荟萃分析；三级。
