Trauma Mortality in Mature Trauma Systems: Are We Doing Better? An Analysis of Trauma Mortality Patterns, 1997-2008
Trauma Mortality in Mature Trauma Systems: Are We Doing Better? An Analysis of Trauma Mortality Patterns, 1997-2008
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DOI：
10.1097/ta.0b013e3181bbfe2a
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发表时间：
2010-09-01
影响因子：
--
通讯作者：
Scalea, Thomas M.
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文献类型：
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作者：
Dutton, Richard P.;Stansbury, Lynn G.;Scalea, Thomas M.
背景：损伤控制手术、止血复苏、方案驱动的脑灌注管理和肺保护性通气等护理方面的进步有望提高重大创伤后的生存率。我们在一个成熟的创伤系统中检查了12年期间的损伤严重程度、死亡率和可预防性，以评估这些和其他改进的总体效益。方法：利用机构创伤登记和质量管理数据库，我们分析了1996年7月1日至2008年6月30日期间所有原发性创伤住院患者的结局和死亡原因，并将这些数据与患者人口统计学、住院时间、死亡时间、预测生存概率和院内死亡的同行评审相关联。结果：通过2007财政年度（FY），主要创伤入院人数，损伤严重程度和年龄增加。以预测的生存概率为基准的性能得到了提高。这一时期的死亡率从3%到3.7%不等，总体上略有恶化（p = 0.04）。然而，在损伤严重程度评分为17-25分的患者中，生存率显著提高（p = 0.0003）。外伤性脑损伤（TBI）占死亡人数的51.6%；急性出血，30%；多器官衰竭，10.5%。无法控制的出血、TBI、多器官衰竭的中位死亡时间分别为2小时、24小时和15天。这些模式并没有随着时间的推移而发生显著变化。结论：在过去的12年中，尽管年龄普遍增加，损伤恶化，但我们中心严重创伤后的生存率和以预测风险为基准的生存率显著提高。创伤护理的进步与人口老龄化和更严重的损伤保持同步，但总体存活率并没有提高。
Background: Advances in care such as damage control surgery, hemostatic resuscitation, protocol-driven cerebral perfusion management, and lung-protective ventilation have promised to improve survival after major trauma. We examined injury severity, mortality, and preventability in a mature trauma system during a 12-year period to assess the overall benefits of these and other improvements.Methods: Using the institutional trauma registry and the quality management database, we analyzed the outcome and the cause of death for all primary trauma admissions from July 1, 1996, to June 30, 2008, and linked these data with patient demographics, hospital length of stay, time to death, predicted probability of survival, and peer review of in-hospital deaths.Results: Through fiscal year (FY) 2007, primary trauma admissions increased in number, injury severity, and age. Performance benchmarked against predicted probability of survival improved. Mortality through this era ranged from 3% to 3.7% and worsened slightly overall (p = 0.04). However, among those patients admitted with Injury Severity Score 17-25, survival improved significantly (p = 0.0003). Traumatic brain injury (TBI) accounted for 51.6% of deaths; acute hemorrhage, 30%; and multiple organ failure, 10.5%. Median time to death for uncontrollable hemorrhage, TBI, multiple organ failure was 2 hours, 24 hours, and 15 days, respectively. These patterns did not change significantly over time.Conclusion: Survival after severe trauma and survival benchmarked against predicted risk improved significantly at our center during the past 12 years despite generally increasing age and worsening injuries. Advances in trauma care have kept pace with an aging population and greater severity of injury, but overall survival has not improved.