ارزيابي نتايح درمان بيماران سانحه ديده در دو مركز آموزشي درماني با استانداردسازي شدت سانحه

Outcome evaluation of injured patients management in two educational centers, using standarization method

Introduction: Nowadays wich injury is one of the major causes of mortality especially in the youngs. To improve the quality of patient management, outcome evaluation of trauma centers has an important role. Since, the compassison of expired patients proportions in different centers, can be biased by different trauma severities (Selection bias), some methods such as standardization, are used to reduce this error. For this purpose, quantitative trauma scoring systems are applicable and the Trauma and Injury Severity Score (TRISS) is an important method in this way. TRISS calculates survival probability of each patient according to standard norms; then, the "z statistics" evaluates the significancy of difference between the actual and the expected number of survivors after standardization of trauma severity. Method: In a cross-sectional study the trauma severity of a sample (525 cases) from two academic centers (Rasoul-Akram & Haft-e-tir Martyrs) was determined. To this purpose, clinical records of all patients and autopsy records of nonsurvivors were evaluated. Results: From the total 525 cases, 6.5 percent were expired. There was a significant difference between the actual number of surviuors (451 persons) and their expected number (457.12 persons) and the Z statistis was -2.29. The W score (-1.27) showed that the mortality of patients must be 1.27 persons in each 100 cases less than now in the standard population of trauma cetners. Discussion: Although z statistics has some limitations but its signigicant reduction usually shows the presence of shortcomings in patients management. The centers with a low z and w scores must be encouraged to assess the management process of patients with unexpected death.