National Study of Undertriage of Trauma Patients

描述(由申请人提供)：医院急诊科(ED)每年治疗超过3000万名伤员，在美国，受伤导致超过17万人死亡。在完善的地区性创伤护理系统中，受伤患者预计会被运送到最合适的目的地医院ED。这种理想的情况并不总是发生在美国，因此许多严重受伤的患者在现场没有得到适当的分流。此外，在非创伤中心急诊室接受治疗的重伤患者中，有很大比例没有被分流到更高级别的创伤中心(分流不足)。虽然有强有力的证据表明，在创伤中心接受治疗的创伤患者的死亡率显著低于在非创伤中心接受治疗的患者，但对分流不足对患者的影响知之甚少。 在三级创伤中心或非创伤中心接受治疗的创伤患者的结局。比较创伤结局研究中的一大挑战是对照组之间危险因素的不平衡，因为创伤患者不是随机分配到医院急诊室的。近年来，倾向评分被用来调整观察性创伤护理研究中的这种不平衡。目前，使用倾向性评分来比较两个治疗组的方法已经很成熟。然而，跨多个群体进行比较的方法还不太成熟。这项R03研究将改进用于多组比较的倾向评分方法，并将在三级和非创伤医院对创伤患者分流不足的全国性研究中应用增强的倾向评分方法。两个具体目标是：目的1)建立和测试倾向评分方法，比较在I、II、III级创伤中心和非创伤中心接受治疗的创伤患者的急诊急诊和住院死亡率(多组比较)；以及目的2)研究在III级和非创伤中心治疗的创伤患者的营养不足的特点和营养不足对死亡率的影响。将使用在美国公开可用的最大的全付款人ED数据库--全国急诊部样本(NEDS)。这项研究提出了一种创新的方法来评估美国不同级别创伤中心急诊室的创伤护理结果，并将在国家一级调查分流不足的特征及其对创伤患者死亡率的影响。研究结果将填补美国创伤患者特征和死亡率RIS方面的重要知识空白。这项研究致力于医疗保健研究和质量机构的比较有效性组合的使命，并将为患者、临床医生和其他决策者提供关于未分流创伤患者死亡风险的循证信息。

DESCRIPTION (provided by applicant): More than 30 million injuries are treated annually in hospital emergency departments (ED), and injuries account for more than 170,000 deaths in the U.S. In a well-established regional trauma care system, injured patients are expected to be transported to the most appropriate destination hospital ED. This ideal situation does not always happen in the U.S. so many patients with serious injuries are not triaged appropriately in the field. Furthermore, a high proportion of severely injured patients who are treated in EDs of non-trauma centers are not triaged to a higher level trauma center (undertriage). While there is strong evidence that trauma patients treated at trauma centers have a significantly lower mortality than if treated at non-trauma centers, little is known about the effect of undertriage on outcomes of trauma patients who were treated at level III or non-trauma centers. One big challenge in comparative trauma outcome study is the imbalance of risk factors between comparison groups because trauma patients are not randomly assigned to hospital EDs. Propensity scores have been used in recent years to adjust for such imbalance in observational trauma care studies. Currently, the methodology of using propensity score in comparing two treatment groups is well established. However, the methods for comparing across multiple groups are less well developed. This R03 research study will enhance the propensity score methods for multiple group comparisons and will apply the enhanced propensity score methodology in a national study of undertriage of trauma patients at level III and non-trauma hospitals. Two specific aims are: Aim 1) to develop and test propensity score methods for comparing ED and inpatient mortality of trauma patients treated at level I, II, III trauma centers and non-trauma centers (multiple group comparisons); and Aim 2) to study characteristics of undertriage and the effect of undertriage on mortality at level III and non-trauma centers. The largest all- payer ED database that is publicly available in the U.S., the Nationwide Emergency Department Sample (NEDS), will be used. This study proposes an innovative approach in assessing trauma care outcomes at EDs of different level trauma centers in the U.S. and will investigate characteristics of undertriage and its impact on mortality in trauma patients at the national level. Results will fill important knowledge gaps in characteristics and the mortality ris of undertriaged trauma patients in the U.S. This study addresses the mission of comparative effectiveness portfolio of the Agency for Healthcare Research and Quality and will provide evidence-based information to patients, clinicians, and other decisions-makers about the mortality risk of undertriaged trauma patients.