Goldberg J, Levy P S, Morkovin V, Goldberg J B
Med Care. 1983 Jul;21(7):692-704.
This study examines a large number of demographic, hospital, patient volume, and medical factors that may influence in-hospital mortality due to trauma. The authors use data from the 1977 and 1978 National Hospital Discharge Survey to assemble a case-control data set of severe injuries (n = 336). Cases are defined as "deaths from trauma," and control subjects are "injured survivors." Control subjects are frequency-matched to cases on the basis of overall severity, site of the most severe anatomic injury, and age. The analysis estimates the relative risk of mortality associated with different levels of the risk factors by the odds ratio. The unadjusted results indicate a significant impact of the following variables: sex (with males at higher risk), average severity of hospital case mix, number of severe trauma patients treated at a hospital (with high-volume hospitals at increased risk), ischemic heart disease and other forms of heart disease, malignant neoplasms, influenza and pneumonia, and emergency tracheotomy or tracheostomy. After adjustment using multiple logistic regression, the single significant risk factor is the presence of ischemic heart disease and other forms of heart disease. The implication of this finding is that hospitals exhibit little difference in mortality from severe trauma after adjustment for patient mix characteristics. Possible explanations for this result are tendered.
本研究考察了大量可能影响创伤患者院内死亡率的人口统计学、医院、患者数量及医学因素。作者利用1977年和1978年全国医院出院调查的数据，组建了一个重伤病例对照数据集（n = 336）。病例被定义为“创伤死亡”，对照对象为“受伤幸存者”。对照对象根据总体严重程度、最严重解剖损伤部位和年龄与病例进行频率匹配。分析通过比值比估计与不同水平危险因素相关的死亡相对风险。未经调整的结果显示以下变量有显著影响：性别（男性风险更高）、医院病例组合的平均严重程度、医院治疗的严重创伤患者数量（高容量医院风险增加）、缺血性心脏病和其他形式的心脏病、恶性肿瘤、流感和肺炎，以及紧急气管切开术或气管造口术。使用多元逻辑回归进行调整后，唯一显著的危险因素是存在缺血性心脏病和其他形式的心脏病。这一发现的意义在于，在对患者组合特征进行调整后，医院在严重创伤死亡率方面差异不大。文中给出了这一结果的可能解释。
