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Regionalized trauma care system in Texas: Implications for redesigning trauma systems

机译：德克萨斯州的区域性创伤护理系统：对重新设计创伤系统的启示

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Background: The aim of this investigation was to evaluate the theoretical framework of regionalized trauma care that places highest expertise at Level I and II Trauma Centers.Material/Methods: To document appropriateness of regionalization the authors examined outcomes of all injured cases hospitalized over 2 years in trauma centers in Texas. The outcome measure was survival following an injury for cases that were treated in any trauma center.Results: Survival was disproportionately lower at Level II and mostly Level I centers compared to centers with lower expertise. When adjusting for severity the difference in survival between centers was of smaller amplitude. Moreover, survival among the cases transferred to Level I and II trauma centers did not differ when adjusting for severity and mortality risk. Patients older than 45, of Hispanic origin, and with some type of insurance were less likely to survive at these centers. Lower survival was associated with shorter length of hospital stay and increased severity.Conclusions: The study raises the question whether regionalization in its current form is the appropriate framework for the organization of trauma care in Texas. Small variation in survival among trauma centers with highest expertise, indicate the need to revisit the entire concept of regionalized traumacare or particular elements of its structure. One solution suggested here is to have multiple centers with similar expertise at the core of the system acting as “Trauma Hospitals” which would connect with all the other hospitals in the region regardless of their expertise in an integrative model .
机译：背景：本研究旨在评估在一级和二级创伤中心拥有最高专业知识的区域性创伤护理的理论框架。材料/方法：为证明区域性的适当性，作者检查了所有住院两年以上受伤病例的结果在德克萨斯州的创伤中心。结果指标是在任何创伤中心接受治疗的患者受伤后的存活率。结果：与专业水平较低的中心相比，II级中心（主要是I级中心）的存活率低得多。调整严重程度后，各中心之间的生存差异较小。此外，在调整严重程度和死亡风险时，转移到I级和II级创伤中心的病例中的生存率没有差异。年龄超过45岁，来自西班牙裔且带有某种保险的患者在这些中心存活的可能性较小。较低的生存率与住院时间短和病情轻重有关。结论：这项研究提出了一个问题，即目前形式的区域化是否是德克萨斯州创伤护理组织的适当框架。具有最高专业知识的创伤中心之间的生存率差异很小，这表明需要重新审视区域性创伤护理的整个概念或其结构的特定要素。这里建议的一种解决方案是在系统的核心中拥有多个具有相似专业知识的中心，作为“创伤医院”，这些中心将与该地区的所有其他医院建立联系，而不论其在集成模型中的专业知识如何。

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