Development of a trauma system and optimal placement of trauma centers using geospatial mapping

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

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Trauma Care at Rural Level III Trauma Centers in a State Trauma System

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000197671.00818.76 ◽

2007 ◽

Vol 62 (2) ◽

pp. 498-503 ◽

Cited By ~ 11

Author(s):

Thomas S. Helling

Keyword(s):

Trauma Care ◽

Trauma System ◽

Trauma Centers

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Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041601 ◽

1995 ◽

Vol 10 (1) ◽

pp. 19-23 ◽

Cited By ~ 11

Author(s):

Michael J. VanRooyen ◽

Edward P. Sloan ◽

John A. Barrett ◽

Robert F. Smith ◽

Hernan M. Reyes

Keyword(s):

Head Injury ◽

Mortality Rate ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Age Groups ◽

Mortality Rates ◽

Trauma Centers ◽

Field Triage ◽

Pediatric Trauma Center

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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Mortality Among Seriously Injured Patients Treated in Remote Rural Trauma Centers Before and After Implementation of a Statewide Trauma System

Medical Care ◽

10.1097/00005650-200107000-00001 ◽

2001 ◽

Vol 39 (7) ◽

pp. 643-653 ◽

Cited By ~ 55

Author(s):

N. Clay Mann ◽

Richard J. Mullins ◽

Jerris R. Hedges ◽

Donna Rowland ◽

Melanie Arthur ◽

...

Keyword(s):

Trauma System ◽

Trauma Centers ◽

Before And After ◽

Injured Patients

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A Comprehensive Analysis of Undertriage in a Mature Trauma System Using Geospatial Mapping

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000003113 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

George Maish ◽

Michael Horst ◽

Catherine Ting Brown ◽

Madison Morgan ◽

Eric Bradburn ◽

...

Keyword(s):

Trauma System ◽

Comprehensive Analysis ◽

Geospatial Mapping

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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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High-Performance Trauma Centers in a Single-State Trauma System

The American Surgeon ◽

10.1177/0003134820934415 ◽

2020 ◽

Vol 86 (7) ◽

pp. 766-772

Author(s):

Justin S. Hatchimonji ◽

Elinore J. Kaufman ◽

Andrew J. Young ◽

Brian P. Smith ◽

Ruiying Xiong ◽

...

Keyword(s):

Mortality Risk ◽

High Performance ◽

Injury Severity ◽

Trauma System ◽

Trauma Centers ◽

High Performing ◽

Patient Level ◽

High Performer ◽

Chi Squared ◽

Expected Mortality

Background Trauma centers with low observed:expected (O:E) mortality ratios are considered high performers; however, it is unknown whether improvements in this ratio are due to a small number of unexpected survivors with high mortality risk (big saves) or a larger number of unexpected survivors with moderate mortality risk (marginal gains). We hypothesized that the highest-performing centers achieve that status via larger numbers of unexpected survivors with moderate mortality risk. Methods We calculated O:E ratios for trauma centers in Pennsylvania for 2016 using a risk-adjusted mortality model. We identified high and low performers as centers whose 95% CIs did not cross 1. We visualized differences between these centers by plotting patient-level observed and expected mortality; we then examined differences in a subset of patients with a predicted mortality of ≥10% using the chi-squared test. Results One high performer and 1 low performer were identified. The high performer managed a population with more blunt injuries (97.2% vs 93.6%, P < .001) and a higher median Injury Severity Score (14 vs 11, P < .001). There was no difference in survival between these centers in patients with an expected mortality of <10% (98.0% vs 96.7%, P = .11) or ≥70% (23.5% vs 10.8%, P = .22), but there was a difference in the subset with an expected mortality of ≥10% (77.5% vs 43.1%, P < .001). Conclusions Though patients with very low predicted mortality do equally well in high-performing and low-performing centers, the fact that performance seems determined by outcomes of patients with moderate predicted mortality favors a “marginal gains” theory.

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