Does Trauma Center Volume Account for the Association Between Trauma Center Verification Level and In-Hospital Mortality among Children Injured by Firearms in California?
Does Trauma Center Volume Account for the Association Between Trauma Center Verification Level and In-Hospital Mortality among Children Injured by Firearms in California?
复制标题
创伤中心的数量是否可以解释创伤中心验证水平与加利福尼亚州枪械致伤儿童的院内死亡率之间的关联？
DOI：
10.1097/xcs.0000000000000818
复制
发表时间：
2023
影响因子：
5.2
通讯作者：
Stey,AnneM
中科院分区：
文献类型：
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作者：
Sullivan,GwynethA;Reddy,Susheel;Reiter,AudraJ;Zeineddin,Suhail;Visenio,Michael;Hu,Andrew;Mackersie,Robert;Kabre,Rashmi;Raval,MehulV;Stey,AnneM
背景：创伤中心指定和损伤体积的异质性为儿科创伤中心指定与儿童较低死亡率之间的不一致提供了可能的解释。我们假设，严格的创伤中心验证，无论数量大小，都将与较低的儿童枪伤相关死亡率相关。STUDY设计：这项回溯性队列研究利用了加州全州卫生规划和发展办公室的患者出院数据。分析了2005年至2018年加州0至14岁儿童直接运输枪伤的数据。美国外科医师学会(ACS)创伤中心验证水平是住院死亡率的主要预测因素。分析了中心的年度火器伤害量数据，作为中心验证水平和住院死亡率之间关系的中介。两个混合效应多变量Logistic回归模型模拟了住院死亡率以及与中心验证的估计相关性，同时调整了患者的人口统计学和临床特征。结果：队列中包括2409名儿童，死亡率为8.6%(n=206)。与非创伤/III/IV创伤中心相比，成人I级创伤中心(调整后的优势比[AOR]0.38，95%CI 0.19至0.80)、儿科创伤中心(AOR 0.17，95%CI 0.05至0.61)和双重创伤中心(AOR 0.48，95%CI 0.25至0.93)的儿童调整后的死亡率较低。枪伤数量并不影响急性呼吸综合征创伤中心验证与死亡率之间的关系(AOR/10患者数量增加1.01，95%可信区间0.99至1.03)。结论：无论武器伤量多少，创伤中心验证水平都与较低的火器伤相关死亡率相关，提示ACS验证过程有助于获得最佳结果。
BACKGROUND:Heterogeneity in trauma center designation and injury volume offer possible explanations for inconsistencies in pediatric trauma center designation’s association with lower mortality among children. We hypothesized that rigorous trauma center verification, regardless of volume, would be associated with lower firearm injury-associated mortality in children.STUDY DESIGN:This retrospective cohort study leveraged the California Office of Statewide Health Planning and Development patient discharge data. Data from children aged 0 to 14 years in California from 2005 to 2018 directly transported with firearm injuries were analyzed. American College of Surgeons (ACS) trauma center verification level was the primary predictor of in-hospital mortality. Centers’ annual firearm injury volume data were analyzed as a mediator of the association between center verification level and in-hospital mortality. Two mixed-effects multivariable logistic regressions modeled in-hospital mortality and the estimated association with center verification while adjusting for patient demographic and clinical characteristics. One model included the center’s firearm injury volume and one did not.RESULTS:The cohort included 2,409 children with a mortality rate of 8.6%(n= 206). Adjusted odds of mortality were lower for children at adult level I (adjusted odds ratio [aOR] 0.38, 95% CI 0.19 to 0.80), pediatric (aOR 0.17, 95% CI 0.05 to 0.61), and dual (aOR 0.48, 95% CI 0.25 to 0.93) trauma centers compared to nontrauma/level III/IV centers. Firearm injury volume did not mediate the association between ACS trauma center verification and mortality (aOR/10 patient increase in volume 1.01, 95% CI 0.99 to 1.03).CONCLUSIONS:Trauma center verification level, regardless of firearm injury volume, was associated with lower firearm injury-associated mortality, suggesting that the ACS verification process is contributing to achieving optimal outcomes.