Sugrue M, Seger M, Sloane D, Compton J, Hillman K, Deane S
Department of Trauma, Liverpool Hospital, Sydney, Australia.
Ir J Med Sci. 1996 Apr-Jun;165(2):99-104. doi: 10.1007/BF02943793.
Survival and mortality outcomes for trauma patients admitted to Liverpool Hospital, Sydney were analysed to determine the adequacy of trauma care. TRISS and ASCOT survival probabilities and peer review were utilised to determine if deaths were avoidable. Evaluation methods were compared for assessment of care. During the study period 2205 trauma patients were admitted, 518 of which fulfilled the study entry criteria. There were 38 deaths. The age and Injury Severity Score (ISS) of survivors was 34 +/- 18 years, 9.8 +/- 9 (mean +/- sd) compared to age and ISS for nonsurvivors 37 +/- 22 years and 45 +/- 22*, *p < 0.001. Peer review suggested that 32 deaths were non avoidable, 4 potentially avoidable and 2 were probably avoidable. TRISS and ASCOT survival probabilities were > 0.5 in 16 and 18 patients respectively. TRISS and ASCOT had low positive predictive value (25%) in identifying avoidable deaths. The Z Score was 1.79. The standardised mortality ratio (SMR) was 1.16. The Effectiveness (E) value for outcome was 0.91. Poor communication within the Area Trauma System was the greatest contributor to avoidable deaths. All trauma deaths need peer review rather than solely relying upon ASCOT and TRISS probabilities to identify "unexpected" deaths for detailed review.
对入住悉尼利物浦医院的创伤患者的生存和死亡结果进行了分析，以确定创伤护理的充分性。采用创伤和损伤严重度评分（TRISS）法及创伤严重度特征评分（ASCOT）法计算生存概率，并通过同行评审来确定死亡是否可避免。对评估护理的方法进行了比较。在研究期间，共收治了2205例创伤患者，其中518例符合研究纳入标准。共有38例死亡。幸存者的年龄和损伤严重度评分（ISS）分别为34±18岁、9.8±9（均值±标准差），而非幸存者的年龄和ISS分别为37±22岁和45±22*，*p<0.001。同行评审表明，32例死亡不可避免，4例可能可避免，2例很可能可避免。TRISS法和ASCOT法计算的生存概率在16例和18例患者中分别>0.5。TRISS法和ASCOT法在识别可避免死亡方面的阳性预测值较低（25%）。Z评分为1.79。标准化死亡率（SMR）为1.16。结果的有效性（E）值为0.91。区域创伤系统内沟通不畅是可避免死亡的最大原因。所有创伤死亡都需要进行同行评审，而不是仅仅依靠ASCOT法和TRISS法的概率来识别“意外”死亡以便进行详细审查。
