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首页> 外文期刊>Injury >A comparison of patient characteristics and survival in two trauma centres located in different countries.
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A comparison of patient characteristics and survival in two trauma centres located in different countries.

机译：比较位于不同国家/地区的两个创伤中心的患者特征和生存率。

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INTRODUCTION: The aim of the study was to compare patient characteristics and mortality in severely injured patients in two trauma centres located in different countries, allowing for differences in case-mix. It represents a direct bench-marking exercise between the trauma centres at the North Staffordshire Hospital (NSH), Stoke-on-Trent, UK and the Oregon Health Sciences University (OHSU) Hospital, Portland, Oregon, USA. METHODS: Patients of all ages admitted to the two hospitals during 1995 and 1996 with an Injury Severity Score >15 were included, except for those who died in the emergency departments. Twenty-three factors were studied, including the Injury Severity Score, Glasgow Coma Score, mechanism of injury and anatomical site of injury. Outcome analysis was based on mortality at discharge. RESULTS: The pattern of trauma differed significantly between Stoke and Portland. Patients from Stoke tended to be older, presented with a lower conscious level and a lower systolic blood pressure and were intubated less frequently before arriving at hospital. Mortality depended on similar factors in both centres, especially age, highest AIS score, systolic blood pressure and Glasgow Coma Score.The crude analysis of mortality showed a highly significant odds-ratio of 1.64 in Stoke compared with Portland. Single-factor adjustments were made for the above four factors, which had a similar influence on mortality in both centres. Adjusting for the first three factors individually did not alter the odds-ratio, which stayed in the range 1.53-1.59 and remained highly significant. Adjusting for the Glasgow Coma Score reduced the odds-ratio to 0.82 and rendered it non-significant. In a multi-factor logistic regression model incorporating all of the factors shown to influence mortality in either centre, the odds-ratio was 1.7 but was not significant. CONCLUSION: The analysis illustrates the limitations and pitfalls of making crude outcome comparisons between centres. Highly significant differences in crude mortality were rendered non-significant by case-mix adjustments, supporting the null hypothesis that the two centres were equally effective in terms of this short-term indicator of outcome. To achieve a meaningful comparison between centres, adjustments must be made for the factors which affect mortality.
机译：引言：本研究的目的是比较位于不同国家/地区的两个创伤中心的重伤患者的特征和死亡率，考虑到病例组合的差异。它代表了英国特伦特河畔斯托克市北斯塔福德郡医院（NSH）创伤中心与美国俄勒冈州波特兰的俄勒冈健康科学大学（OHSU）医院之间的直接基准测试。方法：1995年和1996年在这两家医院收治的所有年龄段的损伤严重度得分均大于15的患者，均包括在急诊室死亡的患者。研究了二十三个因素，包括损伤严重度评分，格拉斯哥昏迷评分，损伤机制和损伤的解剖部位。结果分析基于出院时的死亡率。结果：斯托克和波特兰之间的创伤方式差异显着。斯托克（Stoke）的患者往往年龄较大，意识水平较低，收缩压较低，并且在到达医院之前较少插管。死亡率取决于两个中心的相似因素，特别是年龄，AIS最高得分，收缩压和格拉斯哥昏迷得分。对死亡率的粗略分析显示，斯托克地区的死亡率与波特兰市相比具有非常高的1.64。对上述四个因素进行了单因素调整，这对两个中心的死亡率都有相似的影响。分别针对前三个因素进行调整并没有改变赔率比，该几率保持在1.53-1.59的范围内，并且仍然非常重要。调整格拉斯哥昏迷评分可将比值比降低至0.82，使其变得无关紧要。在包含所有显示影响该中心死亡率的所有因素的多因素logistic回归模型中，比值比为1.7，但并不显着。结论：该分析说明了在中心之间进行粗略结果比较的局限性和陷阱。病例混合调整使粗死亡率的显着差异变得不显着，支持零假设，即就这一短期结果指标而言，两个中心的效果相同。为了在各中心之间进行有意义的比较，必须对影响死亡率的因素进行调整。

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