National Study of Undertriage of Trauma Patients

摘要 医院急诊科（艾德）每年治疗超过3000万例受伤， 在一个完善的地区创伤护理系统中，受伤的人在美国死亡超过17万人。 患者预计将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，所以许多严重受伤的病人没有得到适当的分类， 外地此外，很高比例的严重受伤患者在非创伤急诊室接受治疗 中心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， 在创伤中心治疗的创伤患者死亡率明显低于在非创伤中心治疗的患者， 中心，很少有人知道的影响，分流对创伤患者的结果谁是治疗在 三级或非创伤中心比较创伤结局研究的一个重大挑战是 比较组之间的风险因素，因为创伤患者不是随机分配到医院的 eds.近年来，倾向评分已被用于调整观察中的这种不平衡。 创伤护理研究。目前，使用倾向评分比较两种治疗的方法 团体已经建立。然而，在多个组之间进行比较的方法不太好 开发本R03研究将增强多组的倾向评分方法 比较，并将在一项全国性的分流不足研究中应用增强倾向评分方法 三级医院和非创伤医院的创伤病人的平均死亡率。两个具体目标是：目标1）开发和测试 倾向评分法比较I、II、III级创伤患者的艾德和住院死亡率 创伤中心和非创伤中心（多组比较）;目的2）研究 分类不足以及分类不足对三级和非创伤中心死亡率的影响。最大的- 付款人艾德数据库在美国公开，全国急诊科样本 （NES）将被使用。这项研究提出了一种创新的方法，在评估创伤护理结果， 美国不同级别创伤中心的急诊室，并将调查分类不足的特点及其 在国家一级对创伤患者死亡率的影响。结果将填补重要的知识空白， 特征和死亡风险的不足分诊创伤患者在美国这项研究涉及的 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有关死亡率的循证信息 对创伤患者分类不足的风险。

Abstract 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 risk 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.