Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 1 de 1
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Ano de publicação
Tipo de documento
Intervalo de ano de publicação
1.
J Am Coll Surg ; 218(1): 51-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24355876

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is one of the most common causes of injury-related morbidity and mortality. Access to neurosurgical services is critical to optimal outcomes through reduction of secondary injury. We sought to evaluate variations in access to neurosurgical care across a regional trauma system. STUDY DESIGN: This is a population-based retrospective cohort study of patients who sustained isolated severe TBI from 2005 to 2009. Administrative datasets capturing all emergency department visits and hospitalizations were linked deterministically. Differences between access to a trauma center (TC), defined as direct transport from scene or transfer from a nontrauma center (NTC) as opposed to no access, were evaluated; this included patient level determinants of access to TC and delineation of mortality differences between TC and NTC care. Transfer patterns from NTC to TC were also evaluated. RESULTS: We identified 9,448 patients with isolated severe TBI. Almost two-thirds (60%, n = 5,701) received initial care at an NTC. Of these patients, 30% (n = 1,737) were subsequently transferred to a TC. Thirty-day mortality rates of patients treated at a TC vs NTC were 19% vs 18%, respectively (p = 0.19). Among patients younger than 65 years, 67% received TC care; only 41% of patients older than 65 were treated at a TC (p < 0.01). Mechanism, age, brain hemorrhage, and injury severity were associated with TC care. CONCLUSIONS: Considerable variation in delivery of initial care to TBI patients was identified. Factors such as age and injury characteristics were associated with TC access. Because early TC care in TBI confers survival benefits, the demonstrated variability necessitates improvements in access to care for patients with severe head injuries.


Assuntos
Lesões Encefálicas/cirurgia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Procedimentos Neurocirúrgicos , Centros de Traumatologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ontário , Transferência de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA