Factors Associated With the Disposition of Severely Injured Patients Initially Seen at Non–Trauma Center Emergency Departments

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

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Implementation of the American College of Surgeons Committee on Trauma's Trauma Team Activation Criteria at a Level II Trauma Center Improves Under-Triage for Severely Injured Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.08.636 ◽

2018 ◽

Vol 227 (4) ◽

pp. e235

Author(s):

Alicia A. Heelan Gladden ◽

Erik D. Peltz ◽

Robert C. McIntyre ◽

Stephanie Vega ◽

Catherine G. Velopulos ◽

...

Keyword(s):

Trauma Center ◽

Trauma Team ◽

Severely Injured ◽

Severely Injured Patients ◽

Trauma Team Activation ◽

Level Ii ◽

American College Of Surgeons ◽

Activation Criteria ◽

Injured Patients

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Age and traumatic brain injury as prognostic factors for late-phase mortality in patients defined as polytrauma according to the New Berlin Definition: experiences from a level I trauma center

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03626-w ◽

2020 ◽

Author(s):

V. Weihs ◽

V. Heel ◽

M. Dedeyan ◽

N. W. Lang ◽

S. Frenzel ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Prognostic Factors ◽

Trauma Center ◽

Late Phase ◽

Severely Injured ◽

Severely Injured Patients ◽

Berlin Definition ◽

Severe Tbi ◽

Level I ◽

Injured Patients

Abstract Background The rationale of this study was to identify independent prognostic factors influencing the late-phase survival of polytraumatized patients defined according to the New Berlin Definition. Methods Retrospective data analysis on 173 consecutively polytraumatized patients treated at a level I trauma center between January 2012 and December 2015. Patients were classified into two groups: severely injured patients (ISS > 16) and polytraumatized patients (patients who met the diagnostic criteria for the New Berlin Definition). Results Polytraumatized patients showed significantly lower late-phase and overall survival rates. The presence of traumatic brain injury (TBI) and age > 55 years had a significant influence on the late-phase survival in polytraumatized patients but not in severely injured patients. Despite the percentage of severe TBI being nearly identical in both groups, severe TBI was identified as main cause of death in polytraumatized patients. Furthermore, severe TBI remains the main cause of death in polytraumatized patients > 55 years of age, whereas younger polytraumatized patients (< 55 years of age) tend to die more often due to the acute trauma. Conclusion Our results suggest that age beyond 55 years and concomitant (severe) TBI remain as most important influencing risk factor for the late-phase survival of polytraumatized patients but not in severely injured patients. Level of evidence Prognostic study, level III.

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The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

Journal of Clinical Medicine ◽

10.3390/jcm10081700 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1700

Author(s):

Charlie Sewalt ◽

Esmee Venema ◽

Erik van Zwet ◽

Jan van Ditshuizen ◽

Stephanie Schuit ◽

...

Keyword(s):

Hospital Mortality ◽

Trauma Center ◽

Hospital Volume ◽

Injury Severity ◽

Severely Injured ◽

Trauma Centers ◽

Severely Injured Patients ◽

Level 1 ◽

Injured Patients ◽

Level 1 Trauma Center

Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90–1.04, p = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.

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Factors Influencing Transfer to Higher-Level Trauma Center for Severely Injured Patients: A 10-Year Analysis

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.652 ◽

2020 ◽

Vol 231 (4) ◽

pp. S316-S317

Author(s):

William Shihao Lao ◽

Tracy Truong ◽

George Kasotakis ◽

Suresh Agarwal ◽

Krista Haines

Keyword(s):

Trauma Center ◽

Severely Injured ◽

Severely Injured Patients ◽

Factors Influencing ◽

Injured Patients

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Modified Split-Scan Computed Tomography (CT) Diagnostics of Severely Injured Patients: First Results from a Level I Trauma Center Using a Dedicated Head-and-Neck CT-Angiogram for the Detection of Cervical Artery Dissections

Journal of Clinical Medicine ◽

10.3390/jcm9082568 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2568

Author(s):

Daniel Popp ◽

Claudius Thiedemann ◽

Wolf Bäumler ◽

Antonio Ernstberger ◽

Volker Alt ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Head And Neck ◽

Trauma Center ◽

Artery Dissection ◽

Severely Injured ◽

Resonance Imaging ◽

Severely Injured Patients ◽

Cervical Artery ◽

Level I ◽

Injured Patients

Introduction: Traumatic cervical artery dissections are associated with high mortality and morbidity in severely injured patients. After finding even higher incidences than reported before, we decided to incorporate a dedicated head-and-neck computed tomography angiogram (CT-A) in our imaging routine for patients who have been obviously severely injured or, according to trauma mechanism, are suspected to be severely injured. Materials and Methods: A total of 134 consecutive trauma patients with an ISS ≥ 16 admitted to our level I trauma center during an 18 month period were included. All underwent standardized whole-body CT in a 256-detector row scanner with a dedicated head-and-neck CT-A realized as single-bolus split-scan routine. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed in patients with carotid artery dissection (CAD) and vertebral artery dissection (VAD). Results: Of the 134 patients included, 7 patients had at least one cervical artery dissection (CeAD; 5.2%; 95% CI 1.5–9.0%). Six patients (85.7%) had carotid artery dissections, with one patient having a CAD of both sides and one patient having a CAD and contralateral VAD combined. Two patients (28.6%) showed a VAD. Overall mortality was 14.3%, neurologic morbidity was 28.6%. None of the patients showed any attributable neurologic symptoms on admission. The new scanning protocol led to further 5 patients with suspected CeAD during the study period, all ruled out by additional magnetic resonance imaging with angiogram (MRI/MR-A). Conclusion: A lack of specific neurologic symptoms on admission urges the need for a dedicated imaging pathway for severely injured patients, reliable for the detection of cervical artery dissections. Although our modified CT protocol with mandatory dedicated CT-A led to false positives requiring additional magnetic resonance imaging, it likely helped reduce possible therapeutic delays.

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Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey

CJEM ◽

10.1017/cem.2016.402 ◽

2016 ◽

Vol 19 (06) ◽

pp. 450-458

Author(s):

Hyo Jung Lee ◽

Yeong Jun Ju ◽

Eun-Cheol Park

Keyword(s):

Hospital Discharge ◽

Emergency Departments ◽

Lower Risk ◽

Severely Injured ◽

National Hospital ◽

Severely Injured Patients ◽

Medical Resources ◽

Emergency Medical ◽

Risk Of Mortality ◽

Injured Patients

Abstract Objectives In South Korea, injury is a public health problem due to its high incidence and high mortality. To improve emergency medical systems, the government announced plans to increase the emergency medical resources for each region. This study investigated the association between regional emergency medical resources and mortality during hospitalization in severely injured inpatients. Methods To analyse mortality for severely injured inpatients, we used the Korean National Hospital Discharge In-depth Survey data, consisting of 18,621 hospitalizations from 2005-2012. Generalized estimating equations were analysed to examine the association between mortality during hospitalization and both individual and regional variables. Results Mortality during hospitalization occurred in 913 (4.9%) cases. Patients in regions with a higher number of emergency departments (odds ratio [OR]=0.94, 95% confidence interval [CI]: 0.91-0.98), a higher number of ambulances (OR=0.99, 95% CI: 0.98-0.99), and a higher number of registered nurses per emergency department (OR=0.88, 95% CI: 0.83-0.94) had a lower risk of mortality during hospitalization. Conclusions Our findings suggest that regional emergency medical resources are associated with a lower risk of mortality during hospitalization in severely injured patients. Thus, health care policymakers need to determine the proper distribution of emergency medical resources for each region and the function of emergency departments to provide a superior quality of emergency medical services to patients.

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