The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments
The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments
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DOI：
10.1097/ta.0b013e31803c5665
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发表时间：
2007-11-01
影响因子：
--
通讯作者：
Mullins, Richard J.
中科院分区：
文献类型：
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作者：
Newgard, Craig D.;McConnell, K. John;Mullins, Richard J.
背景虽然受伤的人提出非三级医院例行转移进一步照顾，它是未知的，是否有一个结果的好处与这种做法。我们试图评估从非三级医院急诊科（ED）转移受伤患者是否与提高生存率相关。这是一项回顾性队列分析，纳入了1998年1月至2003年12月期间所有符合国家创伤标准的连续受伤儿童和成人，42家非三级医院急诊室（主要是农村）中的1家，需要住院或转院（n = 10，176）。更高级别的护理转移定义为从艾德到六个一级或二级创伤中心之一的医院间转移。倾向分数被用来调整已知的非随机选择的病人更高层次的护理转移。结果：有10，176例创伤患者就诊于非三级医院急诊室并纳入分析，其中3，785例（37%）从急诊室转至三级医院。转移患者的未校正死亡率较高（比值比[OR] 2.83，95%置信区间[CI] 2.06-3.89）。调整转移倾向后，从艾德转移到三级医院与死亡率降低相关（OR 0.67，95% CI 0.48-0.94），这在转移到一级医院的患者中最强（OR 0.62，95% CI 0.40-0.95）。有没有可测量的好处，患者转移到二级医院（OR 0.82，95%CI 0.47-1.43）。结论：调整后的损伤严重程度和非随机选择的患者转移，创伤患者从非三级急诊转移到主要的创伤中心有较低的院内死亡率比患者留在非创伤医院。承认和提前转让。风险农村创伤患者可能会提高生存在一个区域化的创伤系统。
Background. Although injured persons presenting to nontertiary hospitals are routinely transferred for further care, it is unknown whether there is an outcome benefit associated with this practice. We sought to assess whether the transfer of injured patients from nontertiary hospital emergency departments (EDs) is associated with improved survival.Methods. This was a retrospective cohort analysis of all consecutive injured children and adults meeting state trauma criteria, presenting to I of 42 nontertiary hospital EDs (primarily rural) and requiring either admission or transfer (n = 10,176) from January 1998 through December 2003. Higher level of care transfer was defined as interhospital transfer from the ED to one of six Level I or II trauma centers. Propensity scores were used to adjust for the known nonrandom selection of patients for higher level of care transfer. The outcome measure was inhospital mortality.Results: There were 10,176 trauma patients who presented to nontertiary hospital EDs and were included in the analysis, of which 3,785 (37%) were transferred to a tertiary hospital from the ED. Transfer patients had higher unadjusted mortality (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.06-3.89). After adjusting for the propensity to be transferred, transfer from the ED to a tertiary hospital was associated with a reduction in mortality (OR 0.67, 95% CI 0.48-0.94), which was strongest among patients transferred to Level I hospitals (OR 0.62, 95% CI 0.40-0.95). There was no measurable benefit for patients transferred to Level II hospitals (OR 0.82, 95% CI 0.47-1.43).Conclusions: After adjusting for injury severity and the nonrandom selection of patients for transfer, trauma patients transferred from nontertiary EDs to major trauma centers had lower inhospital mortality than patients remaining in nontrauma hospitals. Recognition and early transfer of at.-risk rural trauma patients may improve survival in a regionalized trauma system.