Outcome analysis of Pennsylvania trauma centers: Factors predictive of nonsurvival in seriously injured patients

被引:75
作者
Pasquale, MD
Peitzman, AB
Bednarski, J
Wasser, TE
机构
[1] Lehigh Valley Hosp Ctr, Div Trauma & Surg Crit Care, Dept Surg, Allentown, PA 18105 USA
[2] Lehigh Valley Hosp Ctr, Dept Hlth Studies, Allentown, PA 18105 USA
[3] Presbyterian Univ Hosp, Div Gen Surg, Pittsburgh, PA 15213 USA
[4] Tri State Emergency Syst Inc, Pittsburgh, PA USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2001年 / 50卷 / 03期
关键词
D O I
10.1097/00005373-200103000-00010
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: The purpose of this study was to evaluate the impact of five trauma center characteristics on survival outcome in nine serious injury categories. Methods: A retrospective analysis of prospectively collected data from 1992 to 1996 on patients older than 14 years of age from 24 accredited trauma centers in Pennsylvania was performed. Trauma center characteristics selected for evaluation were level of accreditation, volume of trauma admissions, presence of in-house trauma surgeons, presence of a surgical residency program, and presence of an on-site medical school. Each of these characteristics was evaluated to determine its impact on survival in the selected serious injuries, A logistic regression model was then created to evaluate the most seriously injured patients as defined by A Severity Characterization of Trauma score of < 0.50, On the basis of the logistic regression model, odd ratios were calculated treating low volume as a significant risk factor for mortality. Results: of the 88,723 patients meeting registry criteria, 13,942 met the serious injury criteria. Independent analysis suggested that accreditation was beneficial regardless of level, volume of patients treated had a direct impact on survival outcome, and the presence of a surgical residency program may confer survival benefit. Of the 13,942 patients with serious injuries, those with A Severity Characterization of Trauma score of < 0.5 were selected for evaluation by logistic regression (n = 3,562), The logistic regression model, however, showed that only volume of patients treated had a consistent association with improved survival. Odds ratio analysis revealed low volume as a significant risk factor for mortality in seven of the nine injuries studied, Conclusion: In this analysis, only volume of patients treated had a direct impact on survival outcome. Accreditation, regardless of level, appears to be beneficial.
引用
收藏
页码:465 / 472
页数:8
相关论文
共 37 条
[1]  
*AM COLL SURG COMM, 1976, OPT HOSP RES CAR INJ
[2]  
[Anonymous], RES OPT CAR INJ PAT
[3]   IMPACT OF A TRAUMA SERVICE ON TRAUMA CARE IN A UNIVERSITY HOSPITAL [J].
BAKER, CC ;
DEGUTIS, LC ;
DESANTIS, J ;
BAUE, AE .
AMERICAN JOURNAL OF SURGERY, 1985, 149 (04) :453-458
[4]   TRAUMA CENTERS IN THE UNITED-STATES - IDENTIFICATION AND EXAMINATION OF KEY CHARACTERISTICS [J].
BAZZOLI, GJ ;
MACKENZIE, EJ .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1995, 38 (01) :103-110
[5]   Improved predictions from a severity characterization of trauma (ASCOT) over trauma and injury severity score [TRISS]: Results of an independent evaluation [J].
Champion, HR ;
Copes, WS ;
Sacco, WJ ;
Frey, CF ;
Holcroft, JW ;
Hoyt, DB ;
Weigelt, JA .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1996, 40 (01) :42-48
[6]   THE MAJOR TRAUMA OUTCOME STUDY - ESTABLISHING NATIONAL NORMS FOR TRAUMA CARE [J].
CHAMPION, HR ;
COPES, WS ;
SACCO, WJ ;
LAWNICK, MM ;
KEAST, SL ;
BAIN, LW ;
FLANAGAN, ME ;
FREY, CF .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1990, 30 (11) :1356-1365
[7]  
CHAMPION HR, 1992, ARCH SURG-CHICAGO, V127, P333
[8]  
DEMETRIADES D, 1995, ARCH SURG-CHICAGO, V130, P216
[9]   DOES PRACTICE MAKE PERFECT .1. THE RELATION BETWEEN HOSPITAL VOLUME AND OUTCOMES FOR SELECTED DIAGNOSTIC CATEGORIES [J].
FLOOD, AB ;
SCOTT, WR ;
EWY, W .
MEDICAL CARE, 1984, 22 (02) :98-114