Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

Abstract

Background Little evidence suggests that trauma centres are associated with a lower risk of mortality in severely injured patients (Injury Severity Score (ISS) ≥16) with multiple injuries in China. The objective of this study was to determine the association between the establishment of trauma centres and mortality among severely injured patients with multiple injuries and to identify some risk factors associated with mortality. Methods A retrospective single-centre study was performed including trauma patients admitted to the First Affiliated Hospital of Nanchang University (FAHNU) between January 2016 and December 2021. To determine whether the establishment of a trauma centre was an independent predictor of mortality, logistic regression analysis and propensity score matching (PSM) were performed. Results Among 431 trauma patients, 172 were enrolled before the trauma centre was built, while 259 were included after the trauma centre was built. A higher frequency of older age and traffic accident injury was found in patients diagnosed after the trauma centre was built. The times for the completion of CT examinations, emergency operations and blood transfusions in the “after trauma centre” group were shorter than those in the “before trauma centre” group. However, the total expenditure of patients was increased. In the overall group, univariate and multivariate logistic regression analyses showed that a higher ISS was an independent predictor for worse mortality (OR = 17.859, 95% CI, 8.207–38.86, P < 0.001), while the establishment of a trauma centre was favourable for patient survival (OR = 0.492), which was also demonstrated by PSM. After determining the cut-off value of time for the completion of CT examination, emergency operation and blood transfusion, we found that the values were within the “golden one hour”, and it was better for patients when the time was less than the cut-off value. Conclusion Our study showed that for severely injured patients, the establishment of a trauma centre was favourable for a lower mortality rate. Furthermore, the completion of a CT examination, emergency surgery and blood transfusion in a timely manner and a lower ISS were associated with a decreased mortality rate.

A multi-center retrospective study on the effect of the establishment of the three-level trauma emergency center system on the success rate of patients with severe multiple injuries in Jiangxi Province, China

“…In our study, a total of 1834 patients with severe multiple injuries were included in nine Jiangxi provincial level 1 trauma emergency centers, including1049 patients in the research group and 785 patients in the control group; 1588 patients were included in fteen Jiangxi provincial level 2 trauma centers, including 884 patients in the study group and 704 patients in the control group, and 3044 patients were included in forty-seven Jiangxi provincial level 3 trauma centers, including 1804 patients in the study group and 1240 patients in the control group. Inclusion criteria were as follows [20]: (1) Patients with ISS score ≥ 16 points (2)The injury involves at least two or more parts of the body, including cranial injury (skull fracture, intracranial hematoma with coma, and so on), neck injury (such as cervical spine injury), thoracic injury (multiple rib fractures, diaphragmatic hernia, etc. ), abdominal injury (intraperitoneal hemorrhage, etc.…”

“…), abdominal injury (intraperitoneal hemorrhage, etc. ), damage to the urogenital system, pelvic fracture, spinal fracture and limb injuries; The exclusion criteria were as follows [20]…”