Yates D W, Woodford M, Hollis S
University Department of Emergency Medicine, Hope Hospital, Salford.
Ann R Coll Surg Engl. 1993 Sep;75(5):321-4.
Comparisons have been made between two methods currently used to assess the effectiveness of management of major trauma. These are the review of fatal cases by senior clinicians and the use of statistical analysis of severity scores. The former was assessed by a re-examination of the Coroners' reports of 508 patients reviewed by senior clinicians at the request of The Royal College of Surgeons of England Working Party on the Management of Patients with Major Injuries. The latter was based on the 665 fatalities on the files of the UK Major Trauma Outcome Study. The two groups of patients had comparable age and sex profiles and broadly similar ranges of injury severity. There were major differences between and inconsistencies within the two assessments. Clinicians more frequently judged death avoidable in those with very severe injuries. In contrast, the statistical analysis suggested, paradoxically, that the proportion of avoidable deaths in those patients who had minor injuries was less than the proportion of avoidable deaths in those who had more serious injuries. These variations underline the limited values of retrospective peer review and will not encourage clinicians to adopt currently available statistical methods. Further refinements of anatomical and physiological scoring systems and their integration to provide a statistically valid and clinically acceptable measure of outcome are essential prerequisites to the wider introduction and success of trauma audit.
目前已对两种用于评估重大创伤管理效果的方法进行了比较。这两种方法分别是资深临床医生对死亡病例的回顾以及对严重程度评分进行统计分析。前者通过重新审查验尸官报告进行评估，这些报告涉及应英国皇家外科医学院重大创伤患者管理工作小组要求由资深临床医生审查的508例患者。后者基于英国重大创伤结局研究档案中的665例死亡病例。两组患者的年龄和性别分布具有可比性，损伤严重程度范围大致相似。两种评估之间存在重大差异且内部存在不一致之处。临床医生更常判定重伤患者的死亡是可避免的。相比之下，统计分析却自相矛盾地表明，轻伤患者中可避免死亡的比例低于重伤患者中可避免死亡的比例。这些差异突显了回顾性同行评审的有限价值，也不会鼓励临床医生采用当前可用的统计方法。进一步完善解剖学和生理学评分系统并将其整合，以提供一种在统计学上有效且临床上可接受的结局衡量标准，是创伤审计更广泛引入和成功的必要前提条件。
