Hartmann J, Gabram S, Jacobs L, Libby M
Department of Trauma and Emergency Services, Hartford Hospital, USA.
Acad Emerg Med. 1996 Dec;3(12):1136-9. doi: 10.1111/j.1553-2712.1996.tb03374.x.
To describe a model for an integrated multidisciplinary trauma service and to compare survival outcomes for patients resuscitated by either emergency medicine (EM) or surgical housestaff assigned to the trauma service.
A prospective observational study was performed using injured patients evaluated in the trauma room at Hartford Hospital from July 1 through December 31, 1995. Inclusion criteria included an ICD-9-CM code of 800 through 959.9 and any of the following: transfer from another hospital, admission to the intensive care unit, hospitalization for > or = 23 hours, survival probability of < or = 90%, or Abbreviated Injury Score of > or = 3. Patients were excluded for burns necessitating transfer to a burn unit for definitive care, and for missing data elements that prevented a patient from being analyzed by the TRISS method. Data elements included mechanism of injury, Injury Severity Score, Revised Trauma Score, probability of survival, age, gender, and whether an EM resident was team leader. Patients in the EM cohort (group 1) were compared with patients for whom a surgical resident was team leader (group 2) for all data elements and for hospital survival. TRISS analysis was performed to evaluate outcomes in comparison with national norms.
After exclusions, 609 patients were left for analysis. There were 141 (30%) resuscitated with an EM resident as team leader. No significant difference was found for matched variables between the groups. Both groups had good comparability with the Major Trauma Outcome Study (MTOS) database baseline, with M scores of 0.949 and 0.942, respectively. Outcomes for both groups also compared favorably with the MTOS norm for survival, with Z scores of 2.38 and 2.35 for groups 1 and 2.
These results suggest that in this model of integrated EM/trauma service, equivalent survival outcomes occur whether EM or surgery housestaff act as team leaders.
描述一种综合多学科创伤服务模式，并比较由急诊医学（EM）或分配到创伤服务的外科住院医师进行复苏的患者的生存结局。
对1995年7月1日至12月31日在哈特福德医院创伤室评估的受伤患者进行前瞻性观察研究。纳入标准包括国际疾病分类第九版临床修订本（ICD - 9 - CM）编码800至959.9，以及以下任何一项：从另一家医院转来、入住重症监护病房、住院时间≥23小时、生存概率≤90%或简明损伤评分≥3。因需要转至烧伤科进行确定性治疗的烧伤患者以及因缺少数据元素而无法通过创伤和损伤严重度评分（TRISS）方法进行分析的患者被排除。数据元素包括损伤机制、损伤严重度评分、修订创伤评分、生存概率、年龄、性别以及急诊住院医师是否为组长。将急诊队列（第1组）中的患者与以外科住院医师为组长的患者（第2组）在所有数据元素和医院生存情况方面进行比较。进行TRISS分析以评估与全国标准相比的结局。
排除后，留下609例患者进行分析。其中141例（30%）由急诊住院医师作为组长进行复苏。两组之间匹配变量未发现显著差异。两组与重大创伤结局研究（MTOS）数据库基线的可比性都很好，M值分别为0.949和0.942。两组的结局与MTOS生存标准相比也都较好，第1组和第2组的Z值分别为2.38和2.35。
这些结果表明，在这种急诊医学/创伤综合服务模式中，无论是急诊还是外科住院医师担任组长，生存结局相当。
