Epidemiological Characteristics Of Trauma Inpatients And Evaluation Of Trauma Care Through Outcomes Study

Background and Objectives: Trauma has been considered a critical preventable public health issue in terms of its morbidity, premature mortality and disability rate. It brings a great amount of direct clinical expenses and indirect economic costs, both to the society and the family. Thus, one of the most important subjects in contemporary trauma research is to constitute an effective trauma care evalutaion system through outcomes study and establish preventive measures based on understanding of incidence patterns and epidemiology of trauma, in order to focilitate trauma care institutions at all levels to continuously improve their clinical strategy and performance.Methods: Medical record home page data of trauma patients admitted into military hospitals at all levels for the year 2001²008 were imported into China Trauma Database by Institute for Traffic Medicine, Third Military Medical University. These data, through epidemiology research and logistic regression methods, were analyzed to study trauma and its special type (burns) in terms of incidence patterns, cause of injury, injury severity, injured body sites and outcomes, thus to further discuss important relative factors which may influence trauma outcome. Risk-adjusted models were used to compare trauma care outcomes of different clinical instituions in aspects of severe trauma, severe motorcycle injuries, severe craniocerebral injuries and severe thorax, abodomen and pelvic trauma. By doing so, we tried to explore possible reasons underlying the outcome differences among hospitals. Risk-adjusted methods were also applied to study outcome differences of severe traffic injury within one clinical institution before and after the establishment of its emergency traffic trauma center.Results:Trauma epidemiology study: (1) A total of 2,227,063 trauma inpatients were admitted into Chinese military hospitals through year 2001²008. This study found a yearly increase in hospital admissions for trauma patients. The highest trauma incidence occurred in summer and the lowest in Feburary. Male victims showed a higher number than female victims, with the former main injury cause was traffic accident and the latter was tumble injury. High risk age bracket of suffering trauma for men were 20 to 39 yr old, while for women 30 to 49 yr. Children younger than 10 yr old were high risk group for burns and head injury. Traffic injuries were the most commonly seen trauma type in all areas and districts except in Southwest area where traffic and tumble injury showed almost the same incidence. Mechanical injuries were often seen in Southwest area, and burns often seen in Northwest area. Traffic injury accounted for more than 50% in trauma and caused the greatest damage; tumble injury came the second. Patients suffering spinal injury had the longest hospital stay, highest admission fee and lowest cure rate. Hospitalization cost for burns was also high. Gender, age, cause of injury, injury severity and body site were relative factors influencing trauma outcome. (2) Admission of burn victims to militry hospitals showed an increase after the year 2004. Burns were more prevalent in May, June, July and August, but tapered off during the autumn and winter months. The two age groups with the highest incidences of burns were the preschool age group and the working group. Scalding was the most common cause of burns in children under 5 years of age. Preschool children suffered most often from burns on multiple body regions and on the trunk, whereas the working age group sustained more head and neck burns. Major burns with 30% TBSA and above were more prevalent in fire-related burns, and preschool-age children had a higher incidence of major burns than the working age group. The incidence of burn-related mortality was significantly higher among males than females. Fatalities were significantly less likely among preschool children compared with the rest of the population. Fire-related burns led to fatalities more often than burns with other causes. Burn area was closely correlated with mortality; when the TBSA was more than 30%, the mortality rate increased significantly. Trauma outcome study: (1) We restricted inclusion to 33 military hospitals that contributed at least 2000 inpatients meeting the inclusion criteria of severe trauma (main injured body site AIS≥3) during 2001 to 2007. A total of 130,480 severely injured patients were subject to study. Grounded on data from these 33 hospitals, we selected 7 important factors that influence severe trauma outcome: gender, age, mechanisms of injury, injured body site, injury severity, admission condition, admission time; based on these critieria we established risk-adjustment models for severe trauma outcome, using logistic regression methods: Logit ( P/(1-P) ) =0.155X₁-1.378X₂₁-0.916X₂₂+0.315X₃+1.494X₄₁+0.315X₄₂-1.006X₅+ 1.152X₆₁+0.084X₆₂+0.108X₇-3.472This model was able to predict patient mortality in severe trauma. By using it, trauma care outcomes of different hospitals could be compared by standard mortality/survival O/E ratio. Moreover, our study used risk-adjustment models to analyze outcomes of some special trauma types, such as severe motorcycle injuries, severe craniocerebral injuries and severe thorax, abodomen and pelvic trauma. The results revealed that performance difference also existed in these hospitals in special trauma type outcomes. Institutions ranking were basically consistent in clinical care outcomes of severe trauma, severe motorcycle injuries and severe craniocerebral injuries; whereas some hospital rank changes significantly in truncal injury care outcomes. (2) We built a risk-adjustment model to compute and compare mortality/survival O/E ratio of severe motorcycle injury within one hospital before and after its establishment of an emergency trauma care center: Logit ( P/(1-P) ) =-1.296X₁₁-0.852X₁₂+1.687X₂₁+0.527X₂₂-0.983X₃+1.152X₄₁- 0.099X₄₂+0.115X₅-3.112This study showed that establishing emergency trauma care centers was a good way to significantly improve the efficiency and quality of medical care of severe traffic trauma and make better outcomes.Discussion: By analyzing the big sample trauma inpatients data collected from China Trauma Database, we can see that trauma and burn inpatients admitted into our military hospitals have unique epidemiological characteristics and patterns in terms of general conditions, incidence time, cause of injury, injury severity, injured body site and outcome, and these findings could provide theoretical support for establishing effective trauma preventive measures and medical care strategy. Additionally, through using important factors relative to trauma care outcome to establish trauma outcome prediction model, and using risk-adjustment methods to study severe trauma outcome, we could evaluate trauma care quality in clinical institutions or performance change within one single hospital at different periods. This study could facilitate medical institutions to target problems existing in trauma care procedures and improve hospital performance correspondingly. However, because raw data were not directly inputed into the trauma database, data loss and lack of uniform inclusion standard were inevitable, which may influence the validity of risk-adjustment models and outcome analysis. Thus, to popularize application of trauma database on a large scale among trauma care institutions and to promote a universal data registration standard were of great significance to trauma study and its clinical performance.