挪威创伤患者入院后的死亡率：一项回顾性观察性全国队列研究。
Mortality after hospital admission for trauma in Norway: A retrospective observational national cohort study.
作者信息
Dehli T, Wisborg T, Johnsen L G, Brattebø G, Eken T
机构信息
Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.
Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Interprofessional Rural Research Team - Finnmark, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway; Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.
出版信息
Injury. 2023 Sep;54(9):110852. doi: 10.1016/j.injury.2023.110852. Epub 2023 May 28.
BACKGROUND
National quality data for trauma care in Norway have not previously been reported. We have therefore assessed crude and risk-adjusted 30-day mortality in trauma cases after primary hospital admission on national and regional levels for 36 acute care hospitals and four regional trauma centres.
METHODS
All patients in the Norwegian Trauma Registry in 2015-2018 were included. Crude and risk-adjusted 30-day mortality was assessed for the total cohort and for severe injuries (Injury Severity Score ≥16), and individual and combined effects of health region, hospital level, and hospital size were studied.
RESULTS
28,415 trauma cases were included. Crude mortality was 3.1% for the total cohort and 14.5% for severe injuries, with no statistically significant difference between regions. Risk-adjusted survival was lower in acute care hospitals than in trauma centres (0.48 fewer excess survivors per 100 patients, P<0.0001), amongst severely injured patients in the Northern health region (4.80 fewer excess survivors per 100 patients, P = 0.004), and in hospitals with <100 trauma admissions per year (0.65 fewer excess survivors than in hospitals with ≥100 admissions, P = 0.01). However, the only statistically significant effects in a multivariable logistic case mix-adjusted descriptive model were hospital level and health region. Case-mix adjusted odds ratio for survival for severely injured patients directly admitted to a trauma centre vs. an acute care hospital was 2.04 (95% CI 1.04-4.00, P = 0.04), and if admitted in the Northern health region vs. all other health regions was 0.47 (95% CI 0.27-0.84, P = 0.01). The proportion of cases admitted directly to the regional trauma centre in the sparsely populated Northern health region was half of that in the other regions (18.4% vs. 37.6%, P<0.0001).
CONCLUSION
Differences in risk-adjusted survival for severe injuries can to a large extent be attributed to whether patients are directly admitted to a trauma centre. This should have implications for planning of transport capacity in remote areas.
背景
挪威此前尚未报告过全国创伤护理质量数据。因此，我们评估了36家急症医院和4个区域创伤中心在国家和地区层面上，创伤病例初次入院后30天的粗死亡率和风险调整死亡率。
方法
纳入2015 - 2018年挪威创伤登记处的所有患者。评估了整个队列以及重伤患者（损伤严重度评分≥16）的粗死亡率和风险调整死亡率，并研究了健康区域、医院级别和医院规模的个体及综合影响。
结果
共纳入28415例创伤病例。整个队列的粗死亡率为3.1%，重伤患者为14.5%，各地区之间无统计学显著差异。急症医院的风险调整后生存率低于创伤中心（每100例患者中额外存活者少0.48例，P<0.0001），在北部健康区域的重伤患者中（每100例患者中额外存活者少4.80例，P = 0.004），以及在每年创伤入院人数<100例的医院中（比每年创伤入院人数≥100例的医院额外存活者少0.65例，P = 0.01）。然而，在多变量逻辑病例组合调整描述模型中，唯一具有统计学显著影响的是医院级别和健康区域。直接入住创伤中心的重伤患者与入住急症医院的患者相比，病例组合调整后的生存比值比为2.04（95%置信区间1.04 - 4.00，P = 0.04），而在北部健康区域入住与在所有其他健康区域入住相比为0.47（95%置信区间0.27 - 0.84，P = 0.01）。在人口稀少的北部健康区域，直接入住区域创伤中心的病例比例是其他区域的一半（18.4%对37.6%，P<0.0001）。
结论
重伤患者风险调整后生存率的差异在很大程度上可归因于患者是否直接入住创伤中心。这对偏远地区的运输能力规划应具有启示意义。
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