ASSESSING EFFECTIVENESS OF A MATURE TRAUMA SYSTEM: ASSOCIATION OF PROXIMITY TO A TRAUMA CENTER WITH LOWER INJURY MORTALITY RATE

AbstractHypothesis:Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.Population:Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.Methods:Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.Results:Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.Conclusions:Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

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Pediatric Trauma Deaths: A Three-Part Analysis from a Nonacademic Trauma Center

The American Surgeon ◽

10.1177/000313480607200311 ◽

2006 ◽

Vol 72 (3) ◽

pp. 249-259

Author(s):

Mary O. Aaland ◽

Thein Hlaing

Keyword(s):

Mortality Rate ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Time Frame ◽

Level Ii ◽

Liver Injuries ◽

Depth Analysis ◽

Trauma Mortality ◽

Trauma Deaths

A three-part analysis was undertaken to assess pediatric trauma mortality in a nonacademic Level II trauma center at Parkview Hospital in Fort Wayne, Indiana. Part I was a comparison of Parkview trauma registry data collected from 1999 through 2003 with those of pediatric and adult trauma centers in Pennsylvania. The same methodology used in Pennsylvania was used for the initial evaluation of pediatric deaths from trauma in our trauma center. Part II was a formal in-depth analysis of all individual pediatric deaths as well as surgical cases with head, spleen, and liver injuries from the same time frame. Part III proposes a new methodology to calculate a risk-adjusted mortality rate based on the TRISS model for the evaluation of a trauma system. The use of specific mortality and surgical intervention rates was not an accurate reflection of trauma center outcome. The proposed risk-adjusted mortality rate calculation is perhaps an effective outcome measure to assess patient care in a trauma system.

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Analyses of clinical outcomes after severe pelvic fractures: an international study

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000238 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000238 ◽

Cited By ~ 1

Author(s):

Kyoungwon Jung ◽

Shokei Matsumoto ◽

Alan Smith ◽

Kyungjin Hwang ◽

John Cook-Jong Lee ◽

...

Keyword(s):

Mortality Rate ◽

South Korea ◽

Trauma Center ◽

Data Bank ◽

Pelvic Fractures ◽

Older Age ◽

Inhospital Mortality ◽

Cox Regression Analysis ◽

Factors Associated ◽

The Usa

BackgroundThis study aimed to compare treatment outcomes between patients with severe pelvic fractures treated at a representative trauma center that was established in Korea since 2015 and matched cases treated in the USA.MethodsTwo cohorts were selected from a single institution trauma database in South Korea (Ajou Trauma Data Bank (ATDB)) and the National Trauma Data Bank (NTDB) in the USA. Adult blunt trauma patients with a pelvic Abbreviated Injury Scale >3 were included. Patients were matched based on covariates that affect mortality rate using a 1:1 propensity score matching (PSM) approach. We compared differences in outcomes between the two groups, performed survival analysis for the cohort after PSM and identified factors associated with mortality. Lastly, we analyzed factors related to outcomes in the ATDB dataset comparing a period prior to the implementation of the trauma center according to US standards, an interim period and a postimplementation period.ResultsAfter PSM, a total of 320 patients (160 in each cohort) were identified for comparison. Inhospital mortality was significantly higher in the ATDB cohort using χ2 test, but it was not statistically significant when using Kaplan-Meier survival curves and Cox regression analysis. Moreover, the mortality rate was similar comparing the NTDB cohort to ATDB data reflecting the post-trauma center establishment period. Older age, lower systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) at admission were factors associated with mortality.DiscussionMortality rate after severe pelvic fractures was significantly associated with older age, lower SBP and GCS scores at admission. Efforts to establish a trauma center in South Korea led to improvement in outcomes, which are comparable to those in US centers.Level of evidenceLevel IV.

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Direct transport of geriatric trauma patients with pelvic fractures to a Level I trauma center within an organized trauma system: impact on two-week incidence of in-hospital complications

The American Journal of Surgery ◽

10.1016/j.amjsurg.2012.05.020 ◽

2012 ◽

Vol 204 (6) ◽

pp. 921-926 ◽

Cited By ~ 7

Author(s):

Tabitha Garwe ◽

Zachary V. Roberts ◽

Roxie M. Albrecht ◽

Ashley E. Morgan ◽

Jeremy J. Johnson ◽

...

Keyword(s):

Trauma Center ◽

Trauma System ◽

Pelvic Fractures ◽

Geriatric Trauma ◽

Trauma Patients ◽

Level I ◽

System Impact

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Is Outcome after Blunt Splenic Injury in Adults Better in High-Volume Trauma Centers?

The American Surgeon ◽

10.1177/000313480507101108 ◽

2005 ◽

Vol 71 (11) ◽

pp. 942-949 ◽

Cited By ~ 3

Author(s):

Brian G. Harbrecht ◽

Mazen S. Zenati ◽

Louis H. Alarcon ◽

Juan B. Ochoa ◽

Juan C. Puyana ◽

...

Keyword(s):

Emergency Department ◽

Trauma Center ◽

Injury Severity ◽

Trauma System ◽

High Volume ◽

Trauma Centers ◽

Case Volume ◽

Center Volume ◽

Low Volume ◽

Outcome Differences

An association between outcome and case volume has been demonstrated for selected complex operations. The relationship between trauma center volume and patient outcome has also been examined, but no clear consensus has been established. The American College of Surgeons (ACS) has published recommendations on optimal trauma center volume for level 1 designation. We examined whether this volume criteria was associated with outcome differences for the treatment of adult blunt splenic injuries. Using a state trauma database, ACS criteria were used to stratify trauma centers into high-volume centers (>240 patients with Injury Severity Score >15 per year) or low-volume centers, and outcome was evaluated. There were 1,829 patients treated at high-volume centers and 1,040 patients treated at low-volume centers. There was no difference in age, gender, emergency department pulse, emergency department systolic blood pressure, or overall mortality between high- and low-volume centers. Patients at low-volume centers were more likely to be treated operatively, but the overall success rate of nonoperative management between high-and low-volume centers was similar. These data suggest that ACS criteria for trauma centers level designation are not associated with differences in outcome in the treatment of adult blunt splenic injuries in this regional trauma system.

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An analysis of pediatric trauma center undertriage in a mature trauma system

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002265 ◽

2019 ◽

Vol 87 (4) ◽

pp. 800-807 ◽

Cited By ~ 3

Author(s):

Amelia T. Rogers ◽

Michael A. Horst ◽

Tawnya M. Vernon ◽

Barbara A. Gaines ◽

Eric H. Bradburn ◽

...

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Pediatric Trauma Center

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Unintentional injury mortality among indigenous communities of Taiwan: trends from 2002 to 2013 and evaluation of a community-based intervention

Injury Prevention ◽

10.1136/injuryprev-2017-042321 ◽

2017 ◽

Vol 25 (1) ◽

pp. 26-30 ◽

Cited By ~ 1

Author(s):

Stephen W Pan ◽

Hiu Ha Chong ◽

Hui-Chuan Kao

Keyword(s):

Mortality Rate ◽

Indigenous Population ◽

Unintentional Injury ◽

Indigenous Communities ◽

Mortality Rates ◽

Community Based ◽

Injury Death ◽

Injury Mortality ◽

Injury Prevention Programme ◽

Disproportionate Burden

IntroductionIndigenous communities in Taiwan shoulder a disproportionate burden of unintentional injury fatalities. We compare unintentional injury mortality rate trends among Taiwan’s indigenous communities and the general population from 2002 to 2013, and evaluate potential impact of a community-based injury prevention programme on indigenous unintentional injury death rates.MethodsStandardised and crude unintentional injury mortality rates were obtained from Taiwan government reports. Segmented linear regression was used to estimate and compare unintentional injury mortality rate trends before and after the intervention.ResultsBetween 2002 and 2013, unintentional injury mortality rates among Taiwan’s indigenous population significantly declined by about 4.5 deaths per 100 000 each year (p<0.0001). During that time, the unintentional injury mortality rate ratio between indigenous Taiwanese and the general population significantly decreased by approximately 1% each successive year (p=0.02). However, we were unable to detect evidence that the ‘Healthy and Safe Tribe’ programme was associated with a statistically significant decrease in the unintentional injury mortality rate trend among indigenous persons (p=0.81).ConclusionTaiwanese indigenous communities remain at significantly higher risk of unintentional injury death, though the gap may be slowly narrowing. We found no evidence that the ‘Healthy and Safe Tribe’ indigenous injury-prevention programme significantly contributed to the nationwide decline in unintentional injury mortality among indigenous Taiwanese communities from 2009 to 2013. Future interventions to address the disproportionate burden of unintentional injury fatalities among indigenous Taiwanese should consider interventions with wider coverage of the indigenous population, and complementing grass roots led community-based interventions with structural policy interventions as well.

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