Deaths and high-risk trauma patients missed by standard trauma data sources.
Deaths and high-risk trauma patients missed by standard trauma data sources.
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标准创伤数据源遗漏了死亡和高风险创伤患者。
DOI：
10.1097/ta.0000000000001616
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Rea,Thomas
中科院分区：
文献类型：
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作者：
Newgard,CraigD;Fu,Rongwei;Lerner,EBrooke;Daya,Mohamud;Wright,Dagan;Jui,Jonathan;Mann,NClay;Bulger,Eileen;Hedges,Jerris;Wittwer,Lynn;Lehrfeld,David;Rea,Thomas
背景创伤登记用于评估和改善创伤护理，但可能会遗漏某些创伤死亡和高危患者。我们使用常用的创伤数据源估计了漏诊死亡和高风险创伤患者的数量，并由此产生了现场创伤分诊质量指标的偏差。方法这是对2011年1月1日至2011年12月31日期间由44个紧急医疗服务机构运送到西北七个县的28家医院并跟踪住院期间的基于人群的前瞻性受伤患者队列进行了预先计划的二次分析。我们对 17,633 名患者采用分层概率抽样设计，加权代表紧急医疗服务转运的所有 53,487 名受伤患者。我们将符合国家创伤数据库 (NTDB) 标准的患者（加权 n= 5,883）、所有到主要创伤中心就诊的受伤患者（加权 n= 16,859）以及所有入院患者（加权 n= 18,433）与完整样本进行了比较。结果包括院内死亡率、损伤严重程度评分 (ISS) 为 16 或更高，以及 24 小时内使用关键资源。 结果 在 53,487 名受伤患者中，有 520 例急诊科和院内死亡，1,745 例 ISS 为 16 或更高，923 例需要早期关键资源。与完整队列相比，NTDB 队列漏掉了 62.1% 的死亡、39.2% 的 ISS 16 或更高级别患者以及 23.8% 需要早期关键资源的患者，尤其是因跌倒受伤并入住非创伤医院的老年人。入院队列错过的患者最少——死亡人数为 23.3%，ISS 为 16 或更高的患者占 10.5%，需要早期资源的患者占 13.1%。与整个队列的分诊敏感性 (66.2%) 相比，敏感性估计范围为 63.6%（所有入院）至 93.4%（NTDB）。与整个队列中的分诊特异性 (87.8%) 相比，估计范围为 36.4% (NTDB) 到 77.3%（所有入院）。 结论 常见的创伤数据来源遗漏了大量的创伤死亡和高风险创伤患者，并且可能对创伤系统质量指标产生有偏差的估计。
BACKGROUNDTrauma registries are used to evaluate and improve trauma care, yet potentially miss certain trauma deaths and high-risk patients. We estimated the number of missed deaths and high-risk trauma patients using commonly available sources of trauma data and resulting bias in quality metrics for field trauma triage.METHODSThis was a preplanned secondary analysis of a population-based prospective cohort of injured patients transported by 44 emergency medical services agencies to 28 hospitals in seven Northwest counties from January 1, 2011 to December 31, 2011 and followed through hospitalization. We used a stratified probability sampling design for 17,633 patients, weighted to represent all 53,487 injured patients transported by emergency medical services. We compared patients meeting National Trauma Data Bank (NTDB) criteria (weighted n= 5,883), all injured patients presenting to major trauma centers (weighted n= 16,859), and all admitted patients (weighted n= 18,433), to the full sample. Outcomes included in-hospital mortality, Injury Severity Score (ISS) of 16 or higher, and critical resource use within 24 hours.RESULTSAmong 53,487 injured patients, there were 520 emergency department and in-hospital deaths, 1,745 with ISS of 16 or higher, and 923 requiring early critical resources. Compared to the full cohort, the NTDB cohort missed 62.1% of deaths, 39.2% of patients with ISS of 16 or higher, and 23.8% requiring early critical resources, especially older adults injured by falls and admitted to nontrauma hospitals. The admission cohort missed the fewest patients—23.3% of deaths, 10.5% with an ISS of 16 or higher, and 13.1% requiring early resources. Compared to triage sensitivity in the full cohort (66.2%), sensitivity estimates ranged from 63.6%(all admissions) to 93.4%(NTDB). Compared to triage specificity in the full cohort (87.8%), estimates ranged from 36.4%(NTDB) to 77.3%(all admissions).CONCLUSIONCommon sources of trauma data miss substantial numbers of trauma deaths and high-risk trauma patients and can generate biased estimates for trauma system quality metrics.