INSTITUTION AND PER-SURGEON VOLUME VERSUS SURVIVAL OUTCOME IN PENNSYLVANIA TRAUMA CENTERS
INSTITUTION AND PER-SURGEON VOLUME VERSUS SURVIVAL OUTCOME IN PENNSYLVANIA TRAUMA CENTERS
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DOI：
10.1016/s0002-9610(99)80299-2
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发表时间：
1995-10-01
影响因子：
3
通讯作者：
SACCO, WJ
中科院分区：
文献类型：
--
作者：
KONVOLINKA, CW;COPES, WS;SACCO, WJ
背景：美国外科医生学会建议创伤中心和外科医生的最低患者数量。然而，这些数字主要基于手术（而非创伤）体积和结果之间关系的研究结果。方法：使用逐步回归，寻找每个创伤中心和每个外科医生的患者体积测量值与生存结果的严重性控制测量值（W）之间的关系。对于显着的 z 值，W 是每 100 名接受治疗的患者比 ASCOT 标准预期的额外（或更少）幸存者数量，当 z 不显着时，W = 0。数据来自 1988 年和 1989 年宾夕法尼亚州认可创伤中心收治的患者。 结果：所有患者和成人钝伤患者的关系分别为 W = -0.3312 + 0.0200 (N-SER(B)/SURG) 和 W = -0.3638 + 0.0248 (N-SER(B)/SURG)，其中 N-SER/SURG 是每位外科医生每年治疗的重伤患者数量，N-SER(B)/SURG 是每位外科医生每年治疗的严重钝伤成人患者数量，使用损伤严重程度量表将严重损伤定义为大于或等于 13，或使用简化损伤量表将大于或等于 3 的头部损伤定义为严重损伤。这些关系解释了所有患者和成人的 W (R(2)) 方差的 36% 和 61%为了实现正常生存率 (W = 0)，95% 置信区间表明，创伤外科医生每年应治疗至少 35 名严重受伤患者，每年至少治疗 28 名严重钝性损伤患者。没有体积相关变量对成人穿透伤患者或儿科患者的 W 预测有显着影响。 结论：这些结果证实了外科医生经验的增加，支持创伤护理的区域化。严重受伤患者的治疗与改善结果相关，并有助于确定实现正常生存所需的最低经验，需要对体积和生存及其他结果之间的关系进行前瞻性研究。
BACKGROUND: The American College of Surgeons recommends minimum patient volumes for trauma centers and surgeons. Those numbers, however, are largely based on results from studies of surgical (but not trauma) relationships between volume and outcome.METHODS: Using stepwise regression, relationships were sought between measures of patient volume per trauma center and per surgeon and a severity-controlled measure of survival outcome (W), For significant z values, W is the number of additional (or fewer) survivors, per 100 patients treated, than expected from ASCOT norms, W = 0 when z is nonsignificant. Data are from patients admitted in 1988 and 1989 to accredited Pennsylvania trauma centers.RESULTS: The relationships found for all patients and for adult blunt-injured patients are W = -0.3312 + 0.0200 (N-SER(B)/SURG) and W = -0.3638 + 0.0248 (N-SER(B)/SURG), respectively, where N-SER/SURG is the number of seriously injured patients treated annually per surgeon and N-SER(B)/SURG is the number of adult patients with serious blunt injuries treated annually per surgeon, Serious injury was defined, using the Injury Severity Scale, as greater than or equal to 13 or, using the Abbreviated injury Scale, as a head injury of greater than or equal to 3. The relationships explained 36% and 61% of the variance in W (R(2) for all patients and adult blunt-injured patients, respectively. To achieve normative survival (W = 0), 95% confidence Intervals suggest that a trauma surgeon should treat at least 35 seriously injured patients per year and at least 28 adult patients with serious blunt injury annually. No volume-related variable was a significant contributor to predictions of W for adult patients with penetrating injuries or for pediatric patients.CONCLUSIONS: These results support the regionalization of trauma care by affirming that increased per-surgeon experience in the treatment of seriously injured patients is associated with improved outcomes and help define the minimum experience needed to achieve normative survival. Prospective study of the relationship between volume and survival and other outcomes is required.