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余益民, 姚志彬, 宛云英, 乔莉, 张海燕. 深圳市2014年创伤急救死亡病例可预防性分析[J]. 中国公共卫生, 2018, 34(8): 1163-1167. DOI: 10.11847/zgggws1117647
引用本文: 余益民, 姚志彬, 宛云英, 乔莉, 张海燕. 深圳市2014年创伤急救死亡病例可预防性分析[J]. 中国公共卫生, 2018, 34(8): 1163-1167. DOI: 10.11847/zgggws1117647
Yi-min YU, Zhi-bin YAO, Yun-ying WAN, . Preventable deaths among trauma patients in Shenzhen city, 2014[J]. Chinese Journal of Public Health, 2018, 34(8): 1163-1167. DOI: 10.11847/zgggws1117647
Citation: Yi-min YU, Zhi-bin YAO, Yun-ying WAN, . Preventable deaths among trauma patients in Shenzhen city, 2014[J]. Chinese Journal of Public Health, 2018, 34(8): 1163-1167. DOI: 10.11847/zgggws1117647

深圳市2014年创伤急救死亡病例可预防性分析

Preventable deaths among trauma patients in Shenzhen city, 2014

  • 摘要:
      目的  通过探索和分析深圳市2014年创伤急救死亡病例的可预防性影响因素,为改进创伤救治质量提供参考依据。
      方法  收集深圳市2014年急救死亡病例调查中创伤患者的调查数据及专家评价数据,选择可能影响死亡可预防性的12项影响因素作为观察指标,通过单因素分析和多因素logistic回归分析得出主要影响因素。同时,对专家小组评价中发现的影响创伤死亡可预防性的问题进行归类分析。
      结果  共238例急诊和院内创伤急救死亡病例纳入分析,创伤可预防性致死率达27.73 %;logistic回归分析结果显示,受伤地点(OR = 2.101,P = 0.045)、受伤机制(OR = 12.784,P = 0.001)、是否转院(OR = 6.836,P = 0.002)、死亡地点(OR = 5.778,P = 0.000)、死亡原因(OR = 4.831,P = 0.000)是创伤死亡可预防性的影响因素。专家评价中,创伤急诊死亡病例问题在院前、急诊和院内3个阶段死亡病例中出现率最高(50.37 %),其中流程问题在各阶段死亡病例中最高,占95.59 %;院内病房死亡病例中,系统问题在3个阶段死亡病例中最高,占50 % 。
      结论  深圳市可预防性死亡发生率高于发达国家报道,创伤急救服务绿色通道实施未到位及急救措施缺乏标准化是导致可预防性死亡的重要原因。创伤救治体系需要重新规划。

     

    Abstract:
      Objective  To explore preventable death rate and its influencing factors among trauma patients in Shenzhen city during 2014 and to provide evidences for improving trauma treatment.
      Methods  We collected the data on all trauma-related deaths occurred within three days of emergency medical treatment in Shenzhen city in 2014. Two experts assessed all records of the data to determine each of the preventable or unpreventable deaths and factors associated with the deaths. We analyzed 12 indicators which could affect the preventable deaths and categorized preventable death-related factors suggested by the experts.
      Results  Of all trauma deaths occurred during pre-hospital or in-hospital emergency medication in 83 medical institutions during 2014 in the city, 238 were eligible to be included in the study, of which, 66 were judged as preventable deaths and the preventable death rate was 27.73%. Logistic regression analyses revealed that significant risk factors for preventable trauma death included injury occurred in a public place (odds ratio OR = 2.101, P = 0.045), injury caused by other than falling (OR = 12.784, P = 0.001), with an inter-hospital transfer (OR = 6.836, P = 0.002), death at emergency department (OR = 5.778, P < 0.001), and death caused by other than brain injury (OR = 4.831, P < 0.001). The results of experts assessment indicated that among all the preventable death-related problematic medical treatments, 50.37% appeared in emergency departments and 95.59% were related to medication processes; for all the inpatient preventable deaths, 50% of the problematic medical treatments were related to the system of emergency medication.
      Conclusion  The preventable death rate in Shenzhen city is higher than that in the developed countries mainly because of the green channel for emergency medical service system has not yet been successfully established and standardized emergency medications are not carried out; the results suggest that of the trauma care system in Shenzhen may need to be redesigned.

     

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