Improved Functional Outcomes for Major Trauma Patients in a Regionalized, Inclusive Trauma System
Improved Functional Outcomes for Major Trauma Patients in a Regionalized, Inclusive Trauma System
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DOI：
10.1097/sla.0b013e31824c4b91
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发表时间：
2012-06-01
影响因子：
9
通讯作者：
Cameron, Peter A.
中科院分区：
文献类型：
--
作者：
Gabbe, Belinda J.;Simpson, Pam M.;Cameron, Peter A.
目的：描述在有组织的创伤系统中管理的重大创伤幸存者的结果，包括随着时间的推移护理水平和结果之间的关系。背景：创伤护理系统旨在减少死亡和残疾。研究发现，创伤护理的区域化降低了死亡率，但对生存质量的影响尚不清楚。创伤系统的评估应包括死亡率和发病率。方法：使用有序Logistic回归分析2006年10月至2009年6月期间有组织创伤系统中钝性重大创伤(创伤严重程度评分15)后12个月功能(格拉斯哥预后量表扩展)预后的预测因素。数据来自以人口为基础的维多利亚州创伤登记处。结果：共有4986名年龄在18岁以上的患者。住院死亡率从2006-2007年的11.9%下降到2008-2009年的9.9%。术后12个月随访率为86%(n=3824)。80%的人报告了功能限制。与2006-2007年相比，2007-2008年[调整后的优势比(AOR)：1.22；95%可信区间：1.05，1.41]和2008-2009年(调整后的优势比：1.16；95%可信区间：1.01，1.34)较好的功能结局的几率有所增加。在重大创伤服务中心(MTS)处理的病例获得了更好的功能结果(AOR：1.22；95%CI：1.03，1.45)。结论：尽管死亡率逐年下降，但风险调整后的功能结果随着时间的推移而改善，在MTS(一级创伤中心)管理的病例显示出更好的功能结果。这些发现提供了早期证据，表明这个包容的、地区化的创伤系统正在实现其目标。
Objective: To describe outcomes of major trauma survivors managed in an organized trauma system, including the association between levels of care and outcomes over time.Background: Trauma care systems aim to reduce deaths and disability. Studies have found that regionalization of trauma care reduces mortality but the impact on quality of survival is unknown. Evaluation of a trauma system should include mortality and morbidity.Methods: Predictors of 12-month functional (Glasgow Outcome Scale-Extended) outcomes after blunt major trauma (Injury Severity Score >15) in an organized trauma system were explored using ordered logistic regression for the period October 2006 to June 2009. Data from the population-based Victorian State Trauma Registry were used.Results: There were 4986 patients older than 18 years. In-hospital mortality decreased from 11.9% in 2006-2007 to 9.9% in 2008-2009. The follow-up rate at 12 months was 86% (n = 3824). Eighty percent reported functional limitations. Odds of better functional outcome increased in the 2007-2008 [adjusted odds ratio (AOR): 1.22; 95% CI: 1.05, 1.41] and 2008-2009 (AOR: 1.16; 95% CI: 1.01, 1.34) years compared with 2006-2007. Cases managed at major trauma services (MTS) achieved better functional outcome (AOR: 1.22; 95% CI: 1.03, 1.45). Female gender, older age, and lower levels of education demonstrated lower adjusted odds of better outcome.Conclusions: Despite an annual decline in mortality, risk-adjusted functional outcomes improved over time, and cases managed at MTS (level-1 trauma centers) demonstrated better functional outcomes. The findings provide early evidence that this inclusive, regionalized trauma system is achieving its aims.