Staff Commitment to Trauma Care Improves Mortality and Length of Stay at a Level I Trauma Center

We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004–2012) that received massive transfusions (≥10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.

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The Evolution of Trauma Care at a Level I Trauma Center

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2005.01.014 ◽

2005 ◽

Vol 200 (6) ◽

pp. 922-929 ◽

Cited By ~ 10

Author(s):

Walter L. Biffl ◽

David T. Harrington ◽

Sarah D. Majercik ◽

Jayne Starring ◽

William G. Cioffi

Keyword(s):

Trauma Care ◽

Trauma Center ◽

Level I

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Establishment, Functioning, Challenges, and One-Year Report of Uttar Pradesh’s First Apex Trauma Center

Indian Journal of Neurotrauma ◽

10.1055/s-0039-3402703 ◽

2019 ◽

Vol 16 (02/03) ◽

pp. 099-105

Author(s):

Mallikarjun Gunjiganvi ◽

Siddharth Rai ◽

Rupali Awale ◽

Amit Agarwal

Keyword(s):

Trauma Care ◽

Trauma Center ◽

Spinal Cord Injuries ◽

Road Traffic ◽

Quality Care ◽

Public Health Problem ◽

Major Public Health Problem ◽

Medical Sciences ◽

Provide Quality Care ◽

Level I

AbstractTrauma is a major public health problem across the world with significant morbidity and mortality. Broadly, it is a disease of middle-aged population and is assuming the status of an epidemic in the 21st century. Road traffic injuries are most common followed by railway injuries, industrial, farming, and domestic injuries, and many others in low- and middle-income countries. Severe traumatic brain injuries are the major proportion with concern for long-term cognitive impairment and high spinal cord injuries due to complete dependence. There is no comprehensive trauma care system covering all geography in India at present. The Government of India (GOI), in 2006, established Jai Prakash Narayan Apex Trauma Center, which is run by All India Institute of Medical Sciences at New Delhi as an apex center to provide quality care, training, research, and registry development. It acts as a role model center for the establishment of new centers and helps in upgradation of existing hospitals to provide quality care trauma services. To curb this epidemic of trauma, GOI envisioned National Trauma Care program during the 11th and 12th Five-Year Plans to strengthen the emergency facilities in government hospitals. Many new centers are coming up with various levels of trauma care across the country. Here we discuss the establishment, resources, initial challenges, trauma burden, and a year of report card of the Uttar Pradesh’s first Level I Apex Trauma Center of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, established with a vision of providing state of the art Level I trauma care to the injured victims.

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Five years experience of trauma care in a German urban level I university trauma center

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-009-9140-y ◽

2009 ◽

Vol 35 (5) ◽

pp. 448-454 ◽

Cited By ~ 6

Author(s):

Hendrik Wyen ◽

Sebastian Wutzler ◽

Miriam Rüsseler ◽

Martin Mack ◽

Felix Walcher ◽

...

Keyword(s):

Trauma Care ◽

Trauma Center ◽

Urban Level ◽

Level I

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Trauma Care Before and After Optimization in a Level-I Trauma Center: Life-Saving Changes

10.26226/morressier.5cffabaef6074e97f94aae7d ◽

2019 ◽

Author(s):

Roos Havermans ◽

Mariska A.C. de Jongh

Keyword(s):

Trauma Care ◽

Trauma Center ◽

Life Saving ◽

Before And After ◽

Level I

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Mass Casualty following Unprecedented Tornadic Events in the Southeast: Natural Disaster Outcomes at a Level I Trauma Center

The American Surgeon ◽

10.1177/000313481207800716 ◽

2012 ◽

Vol 78 (7) ◽

pp. 770-773 ◽

Cited By ~ 4

Author(s):

Elizabeth H. Hartmann ◽

Nathan Creel ◽

Jacob Lepard ◽

Robert A. Maxwell

Keyword(s):

Soft Tissue ◽

Length Of Stay ◽

Emergency Preparedness ◽

Trauma Center ◽

Average Length ◽

Mass Casualty ◽

Incident Command ◽

Trauma Service ◽

Large Patient ◽

Level I

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries.

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Sturgeons versus Surgeons: Leaping Fish Injuries at a Level I Trauma Center

The American Surgeon ◽

10.1177/000313480907500306 ◽

2009 ◽

Vol 75 (3) ◽

pp. 220-222

Author(s):

Jason P. Wilson ◽

George Burgess ◽

Robert D. Winfield ◽

Lawrence Lottenberg

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Trauma Center ◽

Public Awareness ◽

Closed Head Injury ◽

Facial Trauma ◽

Closed Head ◽

Secondary Injuries ◽

Level I

We have recently noted an increase in patients injured by an unusual mechanism and source: leaping sturgeon. We present our experience with eight cases of sturgeon related injuries. Between January 2006 and June 2007, there were eight patients evaluated at our Level I trauma center for sturgeon related injuries. Injuries included isolated fractures, liver lacerations, severe facial trauma, and a closed head injury. The overall length of stay was 6 days (range 0-20) and 50 per cent of patients required an intensive care unit stay. For comparative purposes, injuries were classified as primary sturgeon injuries (injuries where the sturgeon directly impacted the patient) and secondary sturgeon injuries (injuries related to the sturgeon but not resultant from direct impact). There were five primary injuries and three secondary injuries in our series. Patients with secondary injuries had a longer length of stay (12 days vs 3 days) and a higher intensive care unit utilization (100 % vs 20%) when compared with patients having primary injuries. This is the first report of sturgeon-related injuries in the medical literature. These peculiar insults seem to have increased in recent years. Public awareness and proper boat safety are vital in reducing the number and severity of these incidents.

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