Are Outcomes Equivalent for Injured Children Treated at Pediatric Versus Adult Trauma Centers, and What Are the Implications with Respect to the Design of Optimal Trauma Systems?

AbstractAs emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.

Download Full-text

Trauma Systems, Trauma Centers, and Trauma Surgeons

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-199507000-00001 ◽

1995 ◽

Vol 39 (1) ◽

pp. 1-11 ◽

Cited By ~ 39

Author(s):

Ernest E. Moore

Keyword(s):

Trauma Centers ◽

Trauma Systems ◽

Trauma Surgeons

Download Full-text

Trauma Centers and Trauma Systems

JAMA ◽

10.1001/jama.289.12.1566 ◽

2003 ◽

Vol 289 (12) ◽

pp. 1566 ◽

Cited By ~ 24

Author(s):

Donald D. Trunkey

Keyword(s):

Trauma Centers ◽

Trauma Systems

Download Full-text

Population Coverage of Trauma Systems: What Do Helicopters Add?

The American Surgeon ◽

10.1177/000313481908500956 ◽

2019 ◽

Vol 85 (9) ◽

pp. 1073-1078

Author(s):

W. Andrew Smedley ◽

K. Lorraine Stone ◽

John Killian ◽

Allison Brown ◽

Paige Farley ◽

...

Keyword(s):

Trauma Center ◽

Trauma Patients ◽

Trauma Centers ◽

Trauma Systems ◽

Timely Response ◽

Center Care ◽

Added Benefit ◽

Level I ◽

Time Critical ◽

Drive Time

Trauma is a time-critical condition. Helicopters are thought to enhance the accessibility to trauma centers, but this benefit is poorly quantified. The aim of this study was to conduct a geographical analysis of the added benefit provided by helicopters, over ground transport. This study uses geospatial analysis. Helicopter bases and Level I and II designated trauma centers were geocoded. 60-minute drive-time and elliptical flight-time isochrones were mapped with ArcGIS™ (Esri, Redlands, CA). Calculations included allowance for mission ground time (MGT). We compared the proportion of the population that could be taken to Level I and II trauma centers, within 60 minutes, by road and by air. Using a 30-minute MGT model, helicopters permit 279,317 additional residents (5.8%) access to a Level I trauma center within 60 minutes. Using the 20-minute MGT model, 1,089,177 more residents (22.8%) would have access to Level I trauma center care. The benefits were marginally greater for access to Level I and II trauma center care. Helicopters enhance access to specialist trauma center care, but the benefit is small and dependent on MGT. Consideration should be given to the siting of helicopters, particularly in relation to trauma patients, MGT, and the timely response of EMS when determining the triage for helicopter transport.

Download Full-text

Collecting data on organizational structures of trauma centers: the CAFE web service

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000473 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000473

Author(s):

Mathias Brochhausen ◽

Jane W Ball ◽

Nels D Sanddal ◽

Jimm Dodd ◽

Naomi Braun ◽

...

Keyword(s):

Trauma Care ◽

Trauma Center ◽

Organizational Structures ◽

Trauma Centers ◽

Trauma Systems ◽

Improvement Program ◽

Web Based ◽

Organizational Attributes ◽

American College Of Surgeons ◽

Verification Process

BackgroundDuring the past several decades, the American College of Surgeons has led efforts to standardize trauma care through their trauma center verification process and Trauma Quality Improvement Program. Despite these endeavors, great variability remains among trauma centers functioning at the same level. Little research has been conducted on the correlation between trauma center organizational structure and patient outcomes. We are attempting to close this knowledge gap with the Comparative Assessment Framework for Environments of Trauma Care (CAFE) project.MethodsOur first action was to establish a shared terminology that we then used to build the Ontology of Organizational Structures of Trauma centers and Trauma systems (OOSTT). OOSTT underpins the web-based CAFE questionnaire that collects detailed information on the particular organizational attributes of trauma centers and trauma systems. This tool allows users to compare their organizations to an aggregate of other organizations of the same type, while collecting their data.ResultsIn collaboration with the American College of Surgeons Committee on Trauma, we tested the system by entering data from three trauma centers and four trauma systems. We also tested retrieval of answers to competency questions.DiscussionThe data we gather will be made available to public health and implementation science researchers using visualizations. In the next phase of our project, we plan to link the gathered data about trauma center attributes to clinical outcomes.

Download Full-text