Non stéphan, cette communication ne remet pas en cause le golden hour car le median transport time ne croit que de 1 mn.
2008/11/2 Stephan Gascon <[EMAIL PROTECTED]> > Am Surg. 2008 Oct;74(10):930-4. > > > Impact on patient outcomes after closure of an adjacent trauma center. > > Yaghoubian A, Lewis RJ, Putnam BA, De Virgilio C. > Department of Surgery, Harbor-UCLA Medical Center, Torrance, California > 90509, USA. > > In 2005, a major Level I trauma center closed in Los Angeles County, > leading > to media speculation that the sudden expansion of our catchment area would > adversely affect outcome. We sought to determine whether the closure led to > longer transport times and increased trauma morbidity and mortality at our > Level I trauma center. Annual patient volume, paramedic transport times, > injury severity score (ISS), mechanism of injury, complication rate, and > mortality were retrospectively compared between two time periods, Period 1 > (1997-2005, before closure) and Period 2 (March 1, 2005 to March 1, 2006, > after closure), using multivariable logistic regression models. Median > monthly patient volume rose from 123 patients to 190 patients in Period 2 > (P > < 0.01). Median transport time increased from 12 to 13 minutes (P = 0.004) > and median ISS increased from four to five (P < 0.01) in Period 2. The > proportion of patients with ISS > 15 increased from 17 to 24 per cent as > well (P < 0.01). After accounting injury severity, the adjusted mortality > rate decreased in Period 2 (odds ratio 0.69, P = 0.03) and the adjusted > complication rate was unchanged (odds ratio 1.16, P = 0.2). In conclusion, > the closure of a Level I trauma center resulted in a significant increase > in > trauma patient volume and injury severity, as well as a slight increase in > paramedic transport times. However, the adjusted complication rate was > unchanged, and the adjusted mortality rate actually improved. > > Best line: "...and the adjusted mortality rate improved." > > > > > -- > Stéphan Gascon >
