Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems

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.

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

The American Surgeon ◽

10.1177/00031348211033542 ◽

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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A Descriptive Study of the Perceptions of Workplace Violence and Safety Strategies of Nurses Working in Level I Trauma Centers

Journal of Emergency Nursing ◽

10.1016/j.jen.2005.07.008 ◽

2005 ◽

Vol 31 (6) ◽

pp. 519-525 ◽

Cited By ~ 64

Author(s):

Martha Catlette

Keyword(s):

Workplace Violence ◽

Descriptive Study ◽

Trauma Centers ◽

Safety Strategies ◽

Level I

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Children and Terror Casualties Receive Preference in ICU Admissions

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.2012.6 ◽

2012 ◽

Vol 6 (1) ◽

pp. 14-19 ◽

Cited By ~ 4

Author(s):

Kobi Peleg ◽

Michael Rozenfeld ◽

Eran Dolev ◽

Keyword(s):

Traffic Accidents ◽

Injury Severity ◽

Road Traffic ◽

Age Groups ◽

Trauma Patients ◽

Trauma Centers ◽

Severe Injuries ◽

Level I ◽

Hospital Emergency Departments ◽

Trauma Type

ABSTRACTObjective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.(Disaster Med Public Health Preparedness. 2012;6:14–19)

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ARE PATIENTS BEING TRANSFERRED TO LEVEL-I TRAUMA CENTERS FOR REASONS OTHER THAN MEDICAL NECESSITY?

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200610000-00002 ◽

2006 ◽

Vol 88 (10) ◽

pp. 2124-2132

Author(s):

KENNETH J. KOVAL ◽

CHAD W. TINGEY ◽

KEVIN F. SPRATT

Keyword(s):

Trauma Centers ◽

Medical Necessity ◽

Level I

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Poster 062. Delays in Air EMS Activation for Trauma Transports from Community Hospitals to Level-I Trauma Centers

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00050937 ◽

1995 ◽

Vol 10 (S3) ◽

pp. S70-S70

Author(s):

Stephen H. Thomas ◽

Timothy Harrison ◽

Suzanne K. Wedel

Keyword(s):

Trauma Centers ◽

Community Hospitals ◽

Level I

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

The American Surgeon ◽

10.1177/000313480807400510 ◽

2008 ◽

Vol 74 (5) ◽

pp. 413-417 ◽

Cited By ~ 2

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.

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