Strategies for Trauma Centers to Address the Root Causes of Violence: Recommendations from the Improving Social Determinants to Attenuate Violence (ISAVE) Workgroup of the American College of Surgeons Committee on Trauma

2021 ◽  
Author(s):  
Rochelle A. Dicker ◽  
Arielle Thomas ◽  
Eileen M. Bulger ◽  
Ronald M. Stewart ◽  
Stephanie Bonne ◽  
...  
Keyword(s):  
Social Determinants ◽  
Trauma Centers ◽  
American College Of Surgeons ◽  
Causes Of Violence

scholarly journals Effect of the COVID-19 pandemic on the ability of level 1 trauma centers to meet American College of Surgeons research requirements

2021 ◽  
Vol 6 (1) ◽  
pp. e000692
Author(s):  
Robert M Madayag ◽  
Erica Sercy ◽  
Gina M Berg ◽  
Kaysie L Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
American College Of Surgeons ◽  
The Usa ◽  
Virus Exposure ◽  
Level 1 ◽  
Verification Process ◽  
Question Survey

IntroductionThe COVID-19 pandemic has had major effects on hospitals’ ability to perform scientific research while providing patient care and minimizing virus exposure and spread. Many non-COVID-19 research has been halted, and funding has been diverted to COVID-19 research and away from other areas.MethodsA 28-question survey was administered to all level 1 trauma centers in the USA that included questions about how the pandemic affected the trauma centers’ ability to fulfill the volume and research requirements of level 1 verification by the American College of Surgeons (ACS).ResultsThe survey had a 29% response rate (40/137 successful invitations). Over half of respondents (52%) reported reduced trauma admissions during the pandemic, and 7% reported that their admissions dropped below the volume required for level 1 verification. Many centers diverted resources from research during the pandemic (44%), halted ongoing consenting studies (33%), and had difficulty fulfilling research requirements because of competing clinical priorities (40%).DiscussionResults of this study show a need for flexibility in the ACS verification process during the COVID-19 pandemic, potentially including reduction of the required admissions and/or research publication volumes.Level of evidenceLevel IV, cross-sectional study.

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

2020 ◽  
Vol 86 (5) ◽  
pp. 467-475
Author(s):  
Sara Seegert ◽  
Roberta E. Redfern ◽  
Bethany Chapman ◽  
Daniel Benson
Keyword(s):  
Injury Severity ◽  
Trauma Centers ◽  
Activation Level ◽  
American College Of Surgeons ◽  
Before And After ◽  
Trauma Response ◽  
Level 1 ◽  
Transferred Patients ◽  
Trauma Activation ◽  
Level 1 Trauma Center

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

scholarly journals Effect of American College of Surgeons Level 1 Trauma Center Designation on Management of Adult Severe TBI Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Matthew Helton ◽  
Austin Porter ◽  
Kevin Thomas ◽  
Jeffrey C Henson ◽  
Mason Sifford ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Patient Outcomes ◽  
Trauma Center ◽  
Trauma Centers ◽  
Cranial Surgery ◽  
American College Of Surgeons ◽  
Severe Tbi ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

Abstract INTRODUCTION Severe traumatic brain injury (TBI) remains a leading cause of morbidity and mortality. There is a wide variability in treatment paradigm for patients with severe TBI. American College of Surgeons (ACS) level 1 trauma centers have access to 24 h neurosurgical coverage. In this study, we use the National Trauma Database (NTDB) to evaluate if ACS trauma center designation correlates with the management and outcomes of severe TBI in adults. METHODS Adult patients (<65 yr) with a severe isolated nonpenetrating TBI were identified in the NTDB from years 2007 to 2014. ICD-9 procedure codes were used to identify primary treatment approaches: intracranial pressure monitoring and cranial surgery. Multivariate logistic regression was used to determine the impact of ACS designation on procedures and patient outcomes. Patient and injury characteristics were included in the analysis. RESULTS A total of 54 769 TBI patients were identified. Among those, 22 316 (42%) were treated at an ACS level 1 trauma center and 31 835 (58%) were treated elsewhere. Level 1 designated patients had significantly more intracranial pressure (ICP) monitors placed (12.3% vs10.8%; P < .0001) and more cranial surgeries performed (17.7% vs 15.7%; P < .0001). A greater percentage of patients were admitted to the intensive care unit (ICU; 89.9% vs 83.9%; P < .0001) and had a longer hospital stay (16.1 vs 15.2; P < .0001) at ACS level 1 trauma centers. In a regression analysis, patients at level 1 centers were associated with a 14% and 17% increased odds of obtaining a cranial surgery or ICP monitor, respectively. Patients treated at a level 1 center were associated with a 6% decrease in odds of mortality (P = .01). CONCLUSION ACS level 1 designation did correlate with increased rates of neurosurgical intervention and ICU admissions. This translated into patient outcomes as those treated at level 1 facilities were associated with lower rates of mortality.

American College of Surgeons Level I trauma centers outcomes do not correlate with patients’ perception of hospital experience

2017 ◽  
Vol 82 (4) ◽  
pp. 722-727 ◽  
Author(s):  
Bellal Joseph ◽  
Asad Azim ◽  
Terence O’Keeffe ◽  
Kareem Ibraheem ◽  
Narong Kulvatunyou ◽  
...  
Keyword(s):  
Trauma Centers ◽  
Hospital Experience ◽  
American College Of Surgeons ◽  
Level I

Does Resident Trauma Exposure Affect Advanced Trauma Operative Management Course Experience?

2016 ◽  
Vol 82 (3) ◽  
pp. 212-215 ◽  
Author(s):  
Jody M. Kaban ◽  
Melvin E. Stone ◽  
Anand Dayama ◽  
Saman Safadjou ◽  
Srinivas H. Reddy ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Trauma Exposure ◽  
Operative Management ◽  
Trauma Centers ◽  
Operative Trauma ◽  
Traumatic Injuries ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Course Experience ◽  
Different Levels

The Advanced Trauma Operative Management (ATOM) course is a simulation course adopted by the American College of Surgeons to teach operative management of primarily penetrating, traumatic injuries. Although it is clear that overall operative trauma exposure is decreasing, the educational benefit of ATOM for residents with different amounts of trauma exposure remains unclear. Our aim was to determine whether residents from trauma centers experienced less benefit from the ATOM course when compared with residents from nontrauma centers. We compared two groups of residents who take ATOM through our institutional course, those from trauma centers and those from nontrauma centers. ATOM pre- and postcourse evaluations of knowledge and self-efficacy were collected from October 2007 to June 2013. Overall residents from three institutions, two trauma centers (100 residents) and one nontrauma center (34 residents), were included in the study. All resident groups had statistically significant improvement in knowledge and self-efficacy after taking the ATOM course ( P < 0.0001). There was no statistically significant difference in improvement relative to each of the groups in the ATOM categories of knowledge and self-efficacy. Our data show that residents with different levels of trauma exposure had similar pre- and postcourse scores as well as improvement in the ATOM evaluations. As operative trauma continues to decrease the ATOM course shows benefit for all residents regardless of the depth of their clinical trauma exposure in surgical residency.

Analysis of Hospital Ability to Provide Trauma Services: A Comparison between Teaching and Community Hospitals

1991 ◽  
Vol 6 (4) ◽  
pp. 455-458 ◽  
Author(s):  
Keith W. Neely ◽  
Robert L. Norton ◽  
Ed Bartkus ◽  
John A. Schiver
Keyword(s):  
Trauma Care ◽  
Trauma Center ◽  
Trauma System ◽  
Teaching Hospitals ◽  
Trauma Centers ◽  
Ct Scanner ◽  
Community Hospitals ◽  
Availability Analysis ◽  
Level Ii ◽  
American College Of Surgeons

AbstractHypothesis:Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH).Methods:A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiogaphy (ANG); anesthesiologist (ANE); intensive care unit (ICU); on-call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry.Results:With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p<.01).Conclusions:In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability analysis can be performed in other communities to help guide trauma center designation.

The Role of the US Trauma Centers in Older Adult Fall Prevention: A National Survey

2021 ◽  
pp. 000313482110475
Author(s):  
Lisa Allee ◽  
Mark Faul ◽  
Prathima Guntipalli ◽  
Peter A. Burke ◽  
Sowmya R. Rao ◽  
...  
Keyword(s):  
Injury Prevention ◽  
Older Adult ◽  
Fall Prevention ◽  
Prevention Program ◽  
Fall Risk ◽  
Screening Tools ◽  
Trauma Centers ◽  
Fall Prevention Program ◽  
American College Of Surgeons

Introduction Approximately 27.5% of adults 65 and older fall each year, over 3 million are treated in an emergency department, and 32 000 die. The American College of Surgeons and its Committee on Trauma (ACSCOT) have urged trauma centers (TCs) to screen for fall risk, but information on the role of TC in this opportunity for prevention is largely unknown. Methods A 29-item survey was developed by an ACSCOT Injury Prevention and Control Committee, Older Adult Falls workgroup, and emailed to 1000 trauma directors of the National Trauma Data Bank using Qualtrics. US TCs were surveyed regarding fall prevention, screening, intervention, and hospital discharge practices. Data collected and analyzed included respondent’s role, location, population density, state designation or American College of Surgeons (ACS) level, if teaching facility, and patient population. Results Of the 266 (27%) respondents, 71% of TCs include fall prevention as part of their mission, but only 16% of TCs use fall risk screening tools. There was no significant difference between geographic location or ACS level. The number of prevention resources (F = 31.58, P < .0001) followed by the presence of a formal screening tool (F = 21.47, P < .0001) best predicted the presence of a fall prevention program. Conclusion Older adult falls remain a major injury risk and injury prevention opportunity. The majority of TCs surveyed include prevention of older adult falls as part of their mission, but few incorporate the components of a fall prevention program. Development of best practices and requiring TCs to screen and offer interventions may prevent falls.

Prevalence of nonaccidental trauma among children at American College of Surgeons–verified pediatric trauma centers

2017 ◽  
Vol 83 (5) ◽  
pp. 862-866 ◽  
Author(s):  
David D.A. Bogumil ◽  
Natalie E. Demeter ◽  
Karen Kay Imagawa ◽  
Jeffrey S. Upperman ◽  
Rita V. Burke
Keyword(s):  
Pediatric Trauma ◽  
Trauma Centers ◽  
Nonaccidental Trauma ◽  
American College Of Surgeons

Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma

2016 ◽  
Vol 82 (12) ◽  
pp. 1227-1231 ◽  
Author(s):  
Aaron M. Lewis ◽  
Salvador Sordo ◽  
Leonard J. Weireter ◽  
Michelle A. Price ◽  
Leopoldo Cancio ◽  
...  
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Incident Management ◽  
Trauma Centers ◽  
Select Group ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I ◽  
Trauma Surgeons

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

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