Factors associated with patients transferred from undesignated trauma centers to trauma centers.
Factors associated with patients transferred from undesignated trauma centers to trauma centers.
复制标题
与患者从未指定的创伤中心转移到创伤中心相关的因素。
DOI：
10.1097/ta.0000000000000763
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Cassidy,LauraD
中科院分区：
文献类型：
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作者：
Tarima,Sergey;Ertl,Allison;Groner,JonathanI;Cassidy,LauraD
及时获得适当水平的护理，无论是在院前还是在医院环境中，对于优化严重受伤的儿科创伤患者的结局是必要的。然而，很大一部分儿科人群没有足够的及时访问一个验证的1级创伤中心。本研究旨在确定院内死亡率和转移到更高水平护理的重要预测因素。这是第一次全州范围内的分析，包括儿科患者谁是第一次看到在非创伤中心（NTCs）。METHODS死亡率医院间转移到更高层次的护理进行了分析，为第一医院的护理。聚类是由广义估计方程。儿童年龄与所有患者的死亡率显著相关，与受伤不严重儿童的转移显著相关（损伤严重度评分[ISS]<15）。NTC的死亡率低于1级创伤中心;然而，大多数NTC患者被转移，人为地降低了NTC的死亡率。创伤类型（钝性或穿透性）与死亡率和更严重病例的转移显著相关。虽然保险并没有显着相关的转让，自费患者有显着较高的死亡率odds.CONCLUSIONThe NTCs转移98%的患者，即使是那些非常低的ISS和高格拉斯哥昏迷量表（GCS）。对从NTC转移的患者的结局和特征的进一步评估将提供重要信息，以告知分流指南，从而可能安全地避免从其社区的NTC转移伤势较轻的患者。
BACKGROUNDTimely access to the appropriate level of care, both in the prehospital and in the hospital setting, is necessary to optimize outcomes in severely injured pediatric trauma patients. However, a substantial portion of the pediatric population does not have adequate timely access to a verified Level 1 trauma center. This study aimed to identify significant predictors of in-hospital mortality and transfer to a higher level of care. This is the first statewide analysis that includes pediatric patients who are first seen at nontrauma centers (NTCs).METHODSMortality interhospital transfers to a higher level of care were analyzed for the first hospital of care. Clustering was accounted for by generalized estimating equations. p< 0.01 was considered significant.RESULTSYounger age was significantly associated with mortality for all patients and with transfer for less severely injured children (Injury Severity Score [ISS]< 15). The odds of mortality in NTCs were lower than in Level 1 trauma centers; however, the majority of NTC patients were transferred, artificially decreasing NTC mortality. The type of trauma (blunt or penetrating) was significantly associated with both mortality and transfer for more severe cases. Although insurance was not significantly associated with transfer, self-pay patients had significantly higher mortality odds.CONCLUSIONThe NTCs are transferring 98% of their patients, even those with very low ISS and high Glasgow Coma Scale (GCS). Further evaluation of the outcomes and characteristics of patients transferred from NTCs will provide important information to inform the triage guidelines to potentially safely avoid transfer of less severely injured patients from NTCs in their community.