Chebl Ralphe Bou, Diab Razan, Siblini Reem, Bachir Rana, El Sayed Mazen
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Front Med (Lausanne). 2025 Aug 18;12:1591624. doi: 10.3389/fmed.2025.1591624. eCollection 2025.
Sepsis is a major complication in trauma patients, leading to increased morbidity and mortality. Given the varying resource allocation across trauma center levels, the impact of trauma center designation on sepsis-related mortality remains unclear. This study examines the association between trauma center level and sepsis outcomes in trauma patients using data from the National Trauma Data Bank (NTDB) 2017 dataset.
A retrospective cohort study was conducted using the NTDB 2017 dataset at the American University of Beirut (AUB). Trauma patients who developed sepsis as a hospital complication were identified, and those meeting inclusion criteria were analyzed. Patient demographics, comorbidities, injury severity, hospital characteristics, and outcomes were compared across Level I, II, and III trauma centers. Multivariable logistic regression was performed to assess the association between trauma center designation and mortality after adjusting for confounders.
A total of 1,738 patients were included. The study population had a mean age of 56.34 ± 19.54 years, with 72.9% being males and 69.2% of white race. Patients treated in a level I trauma center had a higher injury severity score (ISS ≥ 16) compared to those in other trauma center levels (62.9% vs. 54.5% vs. 22.6%, < 0.001), and increased hospital complications, including ventilator-associated pneumonia (20% vs. 10.7% vs. 5.2%, < 0.001). ICU and OR admissions were significantly higher in Level I and II trauma centers than in Level III (47.9% and 45.9% vs. 30.4% and 30.9%, and 24.1% vs. 13%, < 0.001). Mortality rates were highest in Level I centers (62.4%) compared to Level II (30.8%) and Level III (6.8%), though this difference was not statistically significant after adjustment for confounders ( = 0.691). Multivariable analysis showed no significant association between trauma center designation and sepsis-related mortality when comparing Level II to Level I centers (OR = 0.785, 95% CI: 0.592-1.043; = 0.095) and Level III to Level I centers (OR = 1.038, 95% CI: 0.454-2.372; = 0.930).
Sepsis-related mortality did not significantly differ across trauma level designation when adjusted for potential confounders. These findings highlight the importance of standardized sepsis management protocols across trauma centers as well as the importance of early sepsis recognition and intervention strategies in trauma patients.
脓毒症是创伤患者的主要并发症，会导致发病率和死亡率上升。鉴于不同创伤中心级别之间资源分配的差异，创伤中心指定对脓毒症相关死亡率的影响尚不清楚。本研究使用2017年国家创伤数据库（NTDB）数据集的数据，探讨创伤中心级别与创伤患者脓毒症结局之间的关联。
在美国贝鲁特美国大学（AUB）使用NTDB 2017数据集进行了一项回顾性队列研究。确定发生脓毒症作为医院并发症的创伤患者，并对符合纳入标准的患者进行分析。比较了I级、II级和III级创伤中心的患者人口统计学、合并症、损伤严重程度、医院特征和结局。进行多变量逻辑回归以评估在调整混杂因素后创伤中心指定与死亡率之间的关联。
共纳入1738例患者。研究人群的平均年龄为56.34±19.54岁，男性占72.9%，白人占69.2%。与其他创伤中心级别相比，在I级创伤中心接受治疗的患者损伤严重程度评分（ISS≥16）更高（62.9%对54.5%对22.6%，P<0.001），医院并发症增加，包括呼吸机相关性肺炎（20%对10.7%对5.2%，P<0.001）。I级和II级创伤中心的ICU和手术室入院率显著高于III级（47.9%和45.9%对30.4%和30.9%，以及24.1%对13%，P<0.001）。I级中心的死亡率最高（62.4%），II级为（30.8%），III级为（6.8%），尽管在调整混杂因素后这种差异无统计学意义（P=0.691）。多变量分析显示，比较II级与I级中心（OR=0.785，95%CI：0.592-1.043；P=0.095）和III级与I级中心时，创伤中心指定与脓毒症相关死亡率之间无显著关联（OR=1.038，95%CI：0.454-2.372；P=0.930）。
在调整潜在混杂因素后，脓毒症相关死亡率在不同创伤级别指定之间无显著差异。这些发现突出了跨创伤中心标准化脓毒症管理方案的重要性，以及创伤患者早期脓毒症识别和干预策略的重要性。
