scholarly journals United States level I trauma centers are not created equal – a concern for patient safety?

2008 ◽  
Vol 2 (1) ◽  
Author(s):  
Bruce H Ziran ◽  
Mary-Kate Barrette-Grischow ◽  
Barbara Hileman
Keyword(s):  
United States ◽  
Patient Safety ◽  
Trauma Centers ◽  
Level I

Use of rFVIIa in the Trauma Setting–Practice Patterns in United States Trauma Centers

2008 ◽  
Vol 74 (5) ◽  
pp. 413-417 ◽  
Author(s):  
John D. Horton ◽  
Kent J. Dezee ◽  
Michel Wagner
Keyword(s):  
United States ◽  
Factor Viia ◽  
Drug Level ◽  
High Volume ◽  
Factor Vii ◽  
Trauma Centers ◽  
Packed Red Blood Cells ◽  
Rfviia Administration ◽  
Level I ◽  
Trauma Surgeons

Much excitement has been generated regarding the off label use of recombinant factor VIIa (rFVIIa) in the severely injured trauma patient. The purpose of our study is 3-fold: 1) describe the type of centers that use rFVIIa, 2) determine which centers use the drug more frequently, and finally 3) investigate how this drug is being administered at trauma centers. A survey was mailed or e-mailed to 435 trauma centers (Level I and II) throughout the nation. One hundred fifty-six surveys were returned. American College of Surgeons (ACS) verification and trauma Level I designation were independent predictors of rFVIIa use (odds ratio [OR] 3.74 and 5.40, P < 0.05). High users of rFVIIa were defined as those centers that had above median usage of the drug. Level I centers accounted for 67 per cent of the high users. Only the number of fellowship-trained trauma surgeons and trauma volume predicted high usage of rFVIIa (OR 1.38 and 14.09, P < 0.05). Trauma volume predicted whether or not Factor VII users implemented a protocol based approach to administration of the drug (OR 6.57, P < 0.05). Most protocols incorporated packed red blood cells (74%) before giving rFVIIa. The dose of 90 mcg/kg was exceeded in 34 per cent of centers, and 3 per cent used the 200 mcg/kg dose. High volume Level I trauma centers use rFVIIa more frequently and are more likely to use a systematic approach to its administration. However, there is no standardized approach to rFVIIa administration in United States trauma centers.

The Volume-Outcomes Relationship for United States Level I Trauma Centers

2011 ◽  
Vol 167 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Kyla M. Bennett ◽  
Steven Vaslef ◽  
Theodore N. Pappas ◽  
John E. Scarborough
Keyword(s):  
United States ◽  
Trauma Centers ◽  
Level I

scholarly journals Potential synergy between advanced primary stroke centers and level I or II trauma centers in the United States

2012 ◽  
Vol 30 (8) ◽  
pp. 1535-1539
Author(s):  
Asif A. Khan ◽  
Saqib A. Chaudhry ◽  
Ameer E. Hassan ◽  
Gustavo J. Rodriguez ◽  
M. Fareed K. Suri ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Centers ◽  
Potential Synergy ◽  
Level I

scholarly journals An Overview of Trauma Center Levels and Disparities in Rural Trauma Care

2020 ◽  
Vol 10 ◽  
Author(s):  
Udit Dave ◽  
Brandon Gosine ◽  
Ashwin Palaniappan
Keyword(s):  
United States ◽  
Trauma Care ◽  
Rural Areas ◽  
The United States ◽  
Trauma Centers ◽  
Traumatic Injuries ◽  
Level Ii ◽  
Level I ◽  
Injured Patients

Trauma centers in the United States focus on providing care to patients who have suffered injuries and may require critical care. These trauma centers are classified into five different levels: Level I to Level V. Level V trauma centers are the least comprehensive, providing minimal 24-hour care and resuscitation, and Level I trauma centers are the most comprehensive, accepting the most severely injured patients and always delivering care through the use of an attending surgeon. However, there is a major inequity in access to trauma centers across the United States, especially amongst rural residents. Level III to Level V trauma centers tend to be dominantly situated in rural and underserved areas. Furthermore, trauma centers tend to be widely dispersed with respect to rural areas. Therefore, these areas tend to have a greater mortality rate in relation to traumatic injuries. Improvements in access to high-tier traumatic care must occur in order to reduce mortality due to traumatic injuries in underserved rural areas. Possible improvements to rural trauma care include bolstering the quality of care in Level III trauma centers, increasing Level II center efficiency through the involvement of orthopedic traumatologists, placing medical helicopter bases in more strategic locations that enable transport teams to reach other trauma centers faster, building more Level I and Level II trauma centers, and converting Level III centers into either Level I or Level II centers. 

Potential Synergy between Advanced Primary Stroke Centers and Level I or II Trauma Centers in United States (P07.049)

Neurology ◽  
2012 ◽  
Vol 78 (Meeting Abstracts 1) ◽  
pp. P07.049-P07.049
Author(s):  
A. Khan ◽  
S. Chaudhry ◽  
A. Hassan ◽  
G. Rodrigues ◽  
M. F. Suri ◽  
...  
Keyword(s):  
United States ◽  
Trauma Centers ◽  
Potential Synergy ◽  
Level I

Current clinical protocols for cervical spine clearance in level I trauma centers in the United States

2012 ◽  
Vol 215 (3) ◽  
pp. S63
Author(s):  
Alexander Antonios Theologis ◽  
Robert Dionisio ◽  
Geoffrey Manley ◽  
Robert Mackersie ◽  
Trigg McClellan ◽  
...  
Keyword(s):  
United States ◽  
Cervical Spine ◽  
The United States ◽  
Trauma Centers ◽  
Clinical Protocols ◽  
Level I

Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage

2021 ◽  
pp. 000313482110335
Author(s):  
Alison Smith ◽  
Juan Duchesne ◽  
Matthew Marturano ◽  
Shaun Lawicki ◽  
Kevin Sexton ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Reaction Times ◽  
Maximum Amplitude ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Survival Difference ◽  
Severe Hemorrhage ◽  
Male Patients ◽  
Level I ◽  
Clot Formation Time

Background Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage. Methods A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses. Results A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 ± .9 vs 41.1 ± .6 years, P = .01). On TEG, females had longer reaction times (6.1 ± .9 min vs 4.8 ± .2 min, P = .03), increased alpha angle (68.6 ± .8 vs 65.7 ± .4, P < .001), and higher maximum amplitude (59.8 ± .8 vs 56.3 ± .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 ± 13.7 vs 75.1 ± 2.6 sec, P = .09) and clot formation time (153.6 ± 10.6 sec vs 106.9 ± 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group ( P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48). Conclusions Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed.

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