Ali J, Adam R, Butler A K, Chang H, Howard M, Gonsalves D, Pitt-Miller P, Stedman M, Winn J, Williams J I
Department of Surgery, University of Toronto, Ontario, Canada.
J Trauma. 1993 Jun;34(6):890-8; discussion 898-9. doi: 10.1097/00005373-199306000-00022.
Trauma outcome variables before and after the institution of the Advanced Trauma Life Support (ATLS) program were compared for the largest hospital in Trinidad and Tobago from July 1981 through December 1985 (pre-ATLS) and from January 1986 to June 1990 (post-ATLS). A total of 199 physicians were ATLS trained by June 1990. Outcome data were analyzed for all dead or severely injured patients (ISS > or = 16; n = 413 pre-ATLS and n = 400 post-ATLS). Trauma mortality decreased post-ATLS (134 of 400 vs. 279 of 413) throughout the hospital, including the ICU (13.6% post-ATLS ICU mortality vs. 55.2% pre-ATLS). The odds of dying from trauma increased with age (1.02 for each year), ISS score (1.24 for each ISS increment), and blunt injury, both pre-ATLS and post-ATLS. Post-ATLS mortality was associated with a higher ISS (31.6 vs. 28.8). Although there was a higher percentage of blunt injury pre-ATLS (84.0%) versus post-ATLS (68.3%), the mortality rates for both blunt and penetrating injuries were higher in the pre-ATLS group (19.7% pre-ATLS vs. 6.3% post-ATLS for penetrating and 76.6% pre-ATLS versus 46.2% post-ATLS for blunt). For each ISS category, mortality was greater in the pre-ATLS group (ISS > or = 24 pre-ATLS mortality 47.9% vs. 16.7% post-ATLS; ISS 25-40 pre-ATLS mortality 91.0% vs. 71.0% post-ATLS). The overall ratio of observed to expected mortality based on the MTOS data base was lower for the post-ATLS period (pre-ATLS ratio 3.16; post-ATLS ratio 1.94).(ABSTRACT TRUNCATED AT 250 WORDS)
对特立尼达和多巴哥最大的医院在1981年7月至1985年12月（ATLS项目实施前）以及1986年1月至1990年6月（ATLS项目实施后）期间创伤结局变量进行了比较。到1990年6月共有199名医生接受了ATLS培训。对所有死亡或重伤患者（损伤严重度评分[ISS]≥16；ATLS项目实施前n = 413，实施后n = 400）的结局数据进行了分析。ATLS项目实施后，整个医院包括重症监护病房（ICU）的创伤死亡率均有所下降（400例中有134例死亡，而413例中有279例死亡；ATLS项目实施后ICU死亡率为13.6%，而实施前为55.2%）。在ATLS项目实施前后，因创伤死亡的几率均随年龄（每年1.02）、ISS评分（每个ISS增量为1.24）和钝性损伤而增加。ATLS项目实施后的死亡率与更高的ISS相关（31.6对28.8）。尽管ATLS项目实施前钝性损伤的比例（84.0%）高于实施后（68.3%），但ATLS项目实施前钝性和穿透性损伤的死亡率均更高（穿透性损伤：ATLS项目实施前为19.7%，实施后为6.3%；钝性损伤：ATLS项目实施前为76.6%，实施后为46.2%）。对于每个ISS类别，ATLS项目实施前组的死亡率更高（ISS≥24：ATLS项目实施前死亡率为47.9%，实施后为16.7%；ISS 25 - 40：ATLS项目实施前死亡率为91.0%，实施后为71.0%）。基于MTOS数据库，ATLS项目实施后观察到的死亡率与预期死亡率的总体比率更低（ATLS项目实施前比率为3.16；实施后比率为1.94）。（摘要截短至250字）
