Roh, Young Il
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
,
Kim, Hyung Il
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
,
Cha, Yong Sung
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
,
Cha, Kyoung-Chul
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
,
Kim, Hyun
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
,
Lee, Kang Hyun
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
,
Hwang, Sung Oh
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
,
Kim, Oh Hyun
(Department of Emergency Medicine, Yonsei University Wonju College of Medicine)
Purpose: Trauma systems have been shown to decrease injury-related mortality. The present study aimed to compare the mortality rates of patients with major trauma (injury severity score >15) treated before and after the establishment of a level I trauma center. Methods: During this 20-month study, p...
Purpose: Trauma systems have been shown to decrease injury-related mortality. The present study aimed to compare the mortality rates of patients with major trauma (injury severity score >15) treated before and after the establishment of a level I trauma center. Methods: During this 20-month study, participants were divided into pre-trauma center and trauma center groups, and trauma and injury severity score (TRISS) method was used to compare mortality rates during 10-month periods before and after the establishment of the trauma center (October 2013 to July 2014 vs. October 2014 to July 2015). Results: Of the 541 total participants, 278 (51.5%) visited after the establishment of the trauma center. The Z and W statistics indicated better outcomes in the trauma center group than in the pre-trauma center group (Z statistic, 2.635 vs. -0.700; W statistic, 4.640). The trauma center group also exhibited meaningful reductions in the time interval from the emergency department (ED) visit to emergency surgery (118.0 minutes vs. 142.5 minutes, p=0.020) and the interval from the ED visit to intensive care unit admission (202.0 minutes vs. 259.0 minutes, p=0.035) relative to the pre-trauma center group. Conclusions: The TRISS and multivariate analysis revealed significant improvements in survival rates in the trauma center group, compared to the pre-trauma center group.
Purpose: Trauma systems have been shown to decrease injury-related mortality. The present study aimed to compare the mortality rates of patients with major trauma (injury severity score >15) treated before and after the establishment of a level I trauma center. Methods: During this 20-month study, participants were divided into pre-trauma center and trauma center groups, and trauma and injury severity score (TRISS) method was used to compare mortality rates during 10-month periods before and after the establishment of the trauma center (October 2013 to July 2014 vs. October 2014 to July 2015). Results: Of the 541 total participants, 278 (51.5%) visited after the establishment of the trauma center. The Z and W statistics indicated better outcomes in the trauma center group than in the pre-trauma center group (Z statistic, 2.635 vs. -0.700; W statistic, 4.640). The trauma center group also exhibited meaningful reductions in the time interval from the emergency department (ED) visit to emergency surgery (118.0 minutes vs. 142.5 minutes, p=0.020) and the interval from the ED visit to intensive care unit admission (202.0 minutes vs. 259.0 minutes, p=0.035) relative to the pre-trauma center group. Conclusions: The TRISS and multivariate analysis revealed significant improvements in survival rates in the trauma center group, compared to the pre-trauma center group.
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제안 방법
As the actual effectiveness of a trauma care system can be assessed by its impact on mortality among severely injured patients who would otherwise be expected to die without timely diagnosis and management, this study also evaluated the effect of trauma center care on the outcomes of patients with an ISS of ≥15 and compared these results with the MTOS data from 1987 [12,13].
In this study, we applied the TRISS because this method offers a standard approach for tracking and evaluating the outcome of trauma cares, provides an excellent screening tool for case identification in a quality assurance review, and allows the comparison of outcomes among different populations or trauma patients [9]. The TRISS score is calculated from anatomic, physiologic, and age characteristics and used to quantify the probability of survival (Ps) in patients with major trauma.
Level I trauma centers are required to register with the NEDIS and KTDB. The following data were collected: systolic blood pressure (SBP), diastolic blood pressure, pulse rate, respiratory rate (RR), and Glasgow coma score (GCS) on arrival (measured as part of the initial ED assessment). The following time intervals to outcomes were also measured: time from injury to ED arrival, time from ED visit to emergency surgery, time from ED admission to intensive care unit (ICU) admission, and ICU length of stay (days) or total hospitalization time.
To clarify our findings, we used a multiple logistic regression model adjusted for potential confounders (baseline patient and general characteristics and injury severity) to evaluate the association between trauma center establishment and risk-adjusted survival in the study population (Table 4). Accordingly, we found that the trauma center group had an odds ratio for survival of 1.
대상 데이터
1). Finally, 541 patients were included in this study. Of these, 263 (48.
This study featured an observational cohort design and prospective data collection. The data were obtained from electronic medical records, the National Emergency Department Information System (NEDIS), and the Korean Trauma Data Bank (KTDB). The NEDIS and KTDB were developed to serve as national data repositories and are managed by the Korean government.
데이터처리
We compared the patients’ demographic characteristics and outcome variables using a chi-square analysis or independent t-test.
성능/효과
We attribute this finding to the integration of optimal trauma care, a team-based approach to patient care, and the 24-hour availability of surgery in the trauma center. In conclusion, this study revealed that the survival rate of patients with severe trauma was improved after establishment of a single level I trauma center.
In that study, a multivariate analysis adjusted for age (≤65 and >65 years), mechanism of injury (blunt and penetrating), hypotension on admission (SBP 25) revealed that the adjusted mortality among patients admitted to level I trauma centers was significantly lower than that of patients admitted to level II trauma centers.
The predicted and actual survival rates of patients in the pre-trauma center group were 88.3% and 87.1%, respectively, yielding a 1.2% decrease. In the trauma center group, the predicted and actual survival rates were 86.
참고문헌 (22)
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