Association between trauma quality indicators and outcomes for injured patients.
Association between trauma quality indicators and outcomes for injured patients.
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DOI：
10.1001/archsurg.2011.1327
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发表时间：
2012-04
影响因子：
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通讯作者：
L. Glance;A. Dick;D. Mukamel;T. Osler
中科院分区：
文献类型：
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作者：
L. Glance;A. Dick;D. Mukamel;T. Osler
目的检查美国外科医生学会创伤委员会（ACSCOT）质量指标与结果之间的关联。设计横断面研究。背景数据来自宾夕法尼亚州创伤结果研究。我们研究了2000年至2009年宾夕法尼亚州35家创伤中心收治的210，942名患者的数据。主要观察指标进行回归分析，以检查ACSCOT质量指标和住院死亡率和死亡或主要并发症之间的关系。结果ACSCOT质量指标中有7个与（1）住院死亡率或（2）死亡或主要并发症增加相关。格拉斯哥昏迷量表评分低于13分的患者未进行头部计算机断层扫描与死亡率增加4倍（校正比值比[AOR]，4.39; 95%置信区间[CI]，3.18-6.07）和死亡或重大并发症风险增加近3倍（AOR，2.76; 95% CI 2.05-3.72）相关。腹部枪伤非手术治疗与死亡率增加近5倍相关（AOR，4.80; 95%CI，2.95-7.81）。采用非固定治疗的股骨骨折也与死亡率（AOR，4.08; 95% CI，2.50-6.66）和死亡或严重并发症（AOR，2.54; 95% CI，1.96-3.31）密切相关。结论：目前ACSCOT的几个质量指标与临床结局有很强的相关性。这些研究结果应谨慎解释，因为一些措施可能缺乏表面有效性识别质量差的护理复杂的患者多处受伤。
OBJECTIVE To examine the association between the American College of Surgeons Committee on Trauma (ACSCOT) quality indicators and outcomes. DESIGN Cross-sectional study. SETTING Data from the Pennsylvania Trauma Outcome Study. PATIENTS We studied data from 210,942 patients admitted to 35 trauma centers in Pennsylvania between 2000 and 2009. MAIN OUTCOME MEASURES Regression analyses were performed to examine the association between ACSCOT quality indicators and in-hospital mortality and death or major complications. RESULTS Seven of the ACSCOT quality indicators were associated with either increased (1) in-hospital mortality or (2) death or major complications. No head computed tomography scan in patients with a Glasgow Coma Scale score less than 13 was associated with a 4-fold increase in mortality (adjusted odds ratio [AOR], 4.39; 95% confidence interval [CI], 3.18-6.07) and a nearly 3-fold increased risk of death or major complications (AOR, 2.76; 95% CI 2.05-3.72). Gunshot wounds to the abdomen managed nonoperatively were associated with a nearly 5-fold increase in mortality (AOR, 4.80; 95% CI, 2.95-7.81). Femoral fractures treated with nonfixation were also strongly associated with mortality (AOR, 4.08; 95% CI, 2.50-6.66) and death or major complications (AOR, 2.54; 95% CI, 1.96-3.31). CONCLUSION Several current ACSCOT quality indicators have a strong association with clinical outcomes. These findings should be interpreted with caution because some measures may lack face validity for identifying poor-quality care in complex patients with multiple injuries.