A comparison of patient characteristics and survival in two trauma centres located in different countries
A comparison of patient characteristics and survival in two trauma centres located in different countries
复制标题
DOI：
10.1016/s0020-1383(00)00029-2
复制
发表时间：
2000-09-01
影响因子：
2.5
通讯作者：
Trunkey, DD
中科院分区：
文献类型：
--
作者：
Templeton, J;Oakley, PA;Trunkey, DD
简介：本研究的目的是比较位于不同国家的两个创伤中心的严重受伤患者的患者特征和死亡率。允许病例组合的差异。它代表了英国特伦特河畔斯托克的北斯塔福德郡医院（NSH）和美国俄勒冈州波特兰市俄勒冈健康科学大学（OHSU）医院创伤中心之间的直接基准演习。方法：选取两所医院1995 ~ 1996年收治的损伤严重程度评分为bb0 ~ 15的所有年龄段患者。除了那些死在急诊室的人。研究损伤严重程度评分、格拉斯哥昏迷评分、损伤机制、损伤解剖部位等23个因素。结果分析以出院时死亡率为基础。结果：斯托克和波特兰的创伤模式有显著差异。来自斯托克的患者往往年龄较大，意识水平较低，收缩压较低，在到达医院之前插管次数较少。两个中心的死亡率取决于相似的因素，尤其是年龄，最高AIS评分，收缩压和格拉斯哥昏迷评分。对死亡率的粗略分析显示，斯托克与波特兰的比值比为1.64，非常显著。对上述四个因素进行了单因素调整，这四个因素对两个中心的死亡率都有类似的影响。单独调整前三个因素并没有改变比值比，比值比保持在1.53-1.59之间，仍然非常显著。调整格拉斯哥昏迷评分后，比值比降至0.82，不显著。在多因素logistic回归模型中，纳入了影响两个中心死亡率的所有因素，比值比为1.7，但并不显著。结论：该分析说明了在中心之间进行粗略结果比较的局限性和缺陷。通过病例组合调整，粗死亡率的高度显著差异变得不显著，这支持了原假设，即两个中心在这一短期结果指标方面同样有效。实现中心之间有意义的比较。必须对影响死亡率的因素进行调整。(C) 2000 Elsevier Science Ltd.版权所有。
Introduction: The aim of the study was to compare patient characteristics and mortality in severely injured patients in two trauma centres located in different countries. allowing for differences in case-mix. It represents a direct bench-marking exercise between the trauma centres at the North Staffordshire Hospital (NSH), Stoke-on-Trent, UK and the Oregon Health Sciences University (OHSU) Hospital, Portland, Oregon, USA.Methods: Patients of all ages admitted to the two hospitals during 1995 and 1996 with an Injury Severity Score > 15 were included. except for those who died in the emergency departments. Twenty-three factors were studied, including the Injury Severity Score, Glasgow Coma Score, mechanism of injury and anatomical site of injury. Outcome analysis was based on mortality at discharge.Results: The pattern of trauma differed significantly between Stoke and Portland. Patients from Stoke tended to be older, presented with a lower conscious level and a lower systolic blood pressure and were intubated less frequently before arriving at hospital, Mortality depended on similar factors in both centres, especially age, highest AIS score, systolic blood pressure and Glasgow Coma Score.The crude analysis of mortality showed a highly significant odds-ratio of 1.64 in Stoke compared with Portland. Single-factor adjustments were made for the above four factors, which had a similar influence on mortality in both centres. Adjusting for the first three factors individually did not alter the odds-ratio, which stayed in the range 1.53-1.59 and remained highly significant. Adjusting for the Glasgow Coma Score reduced the odds-ratio to 0.82 and rendered it non-significant. In a multi-factor logistic regression model incorporating all of the factors shown to influence mortality in either centre, the odds-ratio was 1.7 but was not significant.Conclusion: The analysis illustrates the limitations and pitfalls of making crude outcome comparisons between centres. Highly significant differences in crude mortality were rendered non-significant by case-mix adjustments, supporting the null hypothesis that the two centres were equally effective in terms of this short-term indicator of outcome. To achieve a meaningful comparison between centres. adjustments must be made for the factors which affect mortality. (C) 2000 Elsevier Science Ltd. All rights reserved.