Tepas J J, Patel J C, DiScala C, Wears R L, Veldenz H C
Department of Surgery, University of Florida, Health Science Center, Jacksonville 32209, USA.
J Trauma. 1998 May;44(5):827-30; discussion 830-1. doi: 10.1097/00005373-199805000-00014.
Five years experience recorded in a multi-institutional pediatric trauma registry was analyzed to define the relationship between case volume and outcome as measured by mortality.
A total of 30,930 records with complete data were categorized by contributing hospital. Patients with fatal injury as indicated by an injury severity score of 75 or any abbreviated injury scale of 6 were excluded. Each center's experience was stratified by injury severity using injury severity score > or = 15 as indicative of severe injury. Centers were then classified as low volume (LV, 100-500 cases), mid volume (MV, 501-1,000 cases), or high volume (HV, > 1,000 cases). Proportion of patients with severe injury (injury severity score > 15) and mortality were compared among groups using the chi(2) test with significance accepted at p < 0.05. Using the Pediatric Risk Indicator to adjust for mortality risk, the combined hospital experience of each volume group was further analyzed to assess performance with specific levels of increasing injury severity.
Findings demonstrated a trend of increasing mortality with increasing volume, despite a consistent proportion of severe injury. Risk adjusted mortality for each volume class indicates best outcome in the mid level group.
Regardless of overall volume of patients encountered, there is a consistent proportion of severe injury. The increasing mortality with the most severe injuries seen in the high volume centers may reflect overdemand on resources.
分析多机构儿科创伤登记处记录的五年经验，以确定病例数量与以死亡率衡量的结果之间的关系。
共有30930份完整数据记录按提供数据的医院进行分类。损伤严重程度评分为75或任何简略损伤量表评分为6的致命伤患者被排除。每个中心的经验根据损伤严重程度进行分层，损伤严重程度评分≥15表示严重损伤。然后将中心分为低病例量组（LV，100 - 500例）、中等病例量组（MV，501 - 1000例）或高病例量组（HV，>1000例）。使用卡方检验比较各组中严重损伤患者（损伤严重程度评分>15）的比例和死亡率，p<0.05时具有统计学意义。使用儿科风险指标调整死亡风险，进一步分析每个病例量组的综合医院经验，以评估在损伤严重程度不断增加的特定水平下的表现。
研究结果表明，尽管严重损伤的比例一致，但死亡率随病例量增加呈上升趋势。每个病例量组的风险调整死亡率表明中等病例量组的结果最佳。
无论遇到的患者总体数量如何，严重损伤的比例是一致的。高病例量中心中最严重损伤患者死亡率的增加可能反映了对资源的过度需求。
