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At least 19 recordsLinked to original sources
PubMed2002

Impact of a voluntary trauma system on mortality, length of stay, and cost at a level I trauma center.

Trauma systems have been shown to decrease injury-related mortality; however, their development has been slow often requiring legislative codification. The purpose of this study was to evaluate the impact of a voluntary regional trauma system on outcomes at a Level I trauma center. We conducted a retrospective cohort study in an American College of Surgeons-verified Level I trauma center including all patients admitted to a Level I trauma center during the periods April 1995 through March 1996 (T-1) and April 1997 through March 1998 (T-2). Our main outcome measures were in-hospital mortality, hospital length of stay, cost of care Compared with T-1 patients T-2 patients had lower mortality (odds ratio 0.48, 95% confidence interval 0.32-0.71). A similar decline in mortality was observed for the entire six-county region compared with the remainder of the state. Among the most severely injured patients (Injury Severity Score > or = 16) T-2 patients had a shorter length of stay (16.5 vs 19.5 days; P < 0.05) and lower mean cost of care ($29,795 vs $34,983; P < 0.05). A voluntary trauma system can be implemented without the need for legislative mandate. After system implementation patient and financial outcomes were improved at an individual Level I trauma center.

Adult↗
PubMed1993

Trauma outcomes in the rural developing world: comparison with an urban level I trauma center.

Trauma is well known as a major cause of death and disability in the developed world, but has been inadequately studied in developing nations. We reviewed 539 trauma patients admitted from 1987 through 1991 to a rural African hospital, the Holy Family Hospital (HFH) in Berekum, Ghana, and compared these results with 14,270 patients admitted during the same period to a level I trauma center, the Harborview Medical Center (HMC) in Seattle, Washington. At HFH, 59% of patients were seen > 24 hours after injury, compared with 4% of HMC patients (p < 0.001). Only 25% of HFH patients received prehospital care, compared with 82% of HMC patients (p < 0.001). Mean ISS was higher at HMC (10.0 +/- 6.3) than a HFH (6.7 +/- 6.5) (p < 0.001), but trauma mortality rates were identical (6%) at both institutions. Neurologic injuries were the leading cause of death at both HFH (62%) and HMC (54%). There was no significant difference between institutions in mortality for patients with ISS 1-8 (HMC: 0.7% n = 6390; HFH: 0.3%, n = 342). There was a marked decrease in mortality for patients with ISS 9-24 at HMC (3%, n = 3709) compared with HFH (10%, n = 146) (p < 0.001). There was a less pronounced decrease in mortality for patients with ISS > 24 at HMC (41%, n = 1520) compared with HFH (73%, n = 26) (p < 0.01). The type and the severity of injuries causing fatalities in this developing nation suggest that no inexpensive hospital-based changes would improve outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Trauma center versus non-trauma center admissions in adult trauma victims by age and gender.

OBJECTIVE: The admission types and appropriateness of admission of adults with differing levels of injury severity were compared, based on patient age and gender. METHODS: This retrospective study used a statewide hospital discharge dataset. The patients included adults who had sustained trauma related to motor vehicles and were admitted to trauma center (TCs) and non-trauma center (NTCs) hospitals. Using injury severity scores (ISSs) >or= 16 to denote major trauma, the proportion of patients with major traumatic injuries who were admitted to TCs and NTCs was determined. Types of admission (TC versus NTC) were compared by age and gender for four subgroups of men and women, aged 25 to 64 years, and aged 65 years and older. RESULTS: The sample included 5,712 patients. Of those patients with ISS >or= 16, younger men were most likely to be admitted to a TC (82%), and older women were least likely to be admitted to a TC (60%). The proportions of older men and women with ISS >or= 16 who were admitted to a TC were comparable. Among patients with ISS < 16 admitted to NTCs, older women were the highest proportion (65%), and younger men were the lowest proportion (43%). Overall, more older men and women with ISS >or= 16 were admitted to NTCs than would have been expected. Conversely, a statistically significant proportion of younger men and women with ISS<16 were admitted to TCs. CONCLUSION: Findings suggest that older trauma victims whose injuries appear to be serious are admitted to NTCs more often than are younger trauma victims with similarly serious injuries. Additional studies to examine this phenomenon are warranted.

Accidents, Traffic↗
PubMed1993

Characteristics of trauma centers and trauma surgeons.

We surveyed directors of trauma at 408 trauma centers (as indicated by the state chairmen of the American College of Surgeons' Committee on Trauma [ACSCOT]). Of the 408 trauma directors 290 (71%) responded with information relative to their hospitals and the 1537 general surgeons taking trauma call. Altogether, 75% of the surgeons worked on an identified trauma service, 80% belonged to a cadre of surgeons identified as expert, 52% were viewed as full time, 25% provided in-house staff coverage, and 76% had completed an ATLS course. Six percent of the entire group were 60 to 73 years old and demonstrated a commitment to trauma equal to that of their younger cohorts. As a group, the older surgeons took less call, but when community or the institutional call needs were identified, the older surgeons met the challenge.

Adult↗
PubMedDate not supplied

Nursing role innovations: improved outcomes in a trauma center.

Trauma systems operate on the principle that people with severe injuries require special medical capabilities if they are to have their best chance of recovery. However, optimal trauma care is threatened by the problems of inadequate financial reimbursement. This threatens the ability to deliver trauma patient care. A variety of strategies is necessary to continue to provide care. Two specific nursing role innovations provide the opportunity to improve the ability to provide coordinated, efficient, and cost-effective quality care.

Case Management↗
PubMed1990

Do trauma centers improve outcome over non-trauma centers: the evaluation of regional trauma care using discharge abstract data and patient management categories.

Development of regional medical care systems to treat patients who sustain major accidental injuries (trauma victims) has been based on autopsy studies which demonstrate that hospitals that meet certain accepted criteria of readiness (trauma centers) can prevent needless deaths of trauma victims. However, since only autopsy data have been available from non-trauma centers, it has not previously been possible to compare morbidity data between trauma centers and non-trauma hospitals. This study examines discharge abstract data and a new patient classification system called patient management categories (PMC) which are generated from this abstract data to evaluate length of stay (LOS), complications, and death to compare morbidity and mortality data from trauma centers and non-trauma centers. Discharge abstracts for 1,332 patients with the PMC of femoral shaft fracture with operation were obtained from all hospitals in Western Pennsylvania and Maryland for 1 year. Data from trauma centers were identified and compared to non-trauma centers using the following criteria: time to OR (less than or equal to 2 days vs. greater than 2 days), age (0-12, 13-55, greater than 55 years), associated injuries, and development of complications and death. Patients treated in trauma centers had significantly fewer complications (21% vs. 33%; p less than 0.001) and lower mortality rates (p less than 0.05) than those treated in non-trauma centers. Associated injuries, age, complications, and/or delay in time to OR significantly increased intensity and length of stay in both trauma and non-trauma centers. This significantly increased the cost of care provided to these patients in both types of centers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

The synergistic relationship between a level I trauma center and a regional pediatric trauma center.

A regional pediatric trauma center and a level I trauma center with pediatric commitment in the same city developed a synergistic relationship addressing all aspects of care for pediatric trauma patients. Although it is unlikely that this model could be used in its entirety by all similar institutions, the principles may prove helpful in creating guidelines and relationships. Categorization, optimal use of resources, timely transportation of seriously injured children to the appropriate facility, and maintaining urgent care capabilities of each institution to care for seriously injured children are imperative. The combined effort resulted in our level I trauma center being verified by the American College of Surgeons and designated by our state Health Department as meeting all the criteria for pediatric trauma care. This experience should encourage every pediatric trauma center located in a children's hospital to become a regional pediatric trauma center. The real benefit from the relationship is that injured children receive optimal care at both institutions.

Adult↗
PubMed2005

The effect of trauma center designation and trauma volume on outcome in specific severe injuries.

OBJECTIVE: The objective of this study was to investigate the effect of American College of Surgeons (ACS) trauma center designation and trauma volume on outcome in patients with specific severe injuries. BACKGROUND: Trauma centers are designated by the ACS into different levels on the basis of resources, trauma volume, and educational and research commitment. The criteria for trauma center designation are arbitrary and have never been validated. METHODS: The National Trauma Data Bank study, which included patients >14 years of age and had injury severity score (ISS) >15, were alive on admission and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, cardiac, grade IV/V liver injuries, quadriplegia, or complex pelvic fractures. Outcomes (mortality, intensive care unit stay, and severe disability at discharge) were compared among level I and II trauma centers and between centers within the same level designation but different volumes of severe trauma (<240 vs > or =240 trauma admissions with ISS >15 per year). The outcomes were adjusted for age (<65 > or =65), gender, mechanism of injury, hypotension on admission, and ISS (< or =25 and >25). RESULTS: A total of 12,254 patients met the inclusion criteria. Overall, level I centers had significantly lower mortality (25.3% vs 29.3%; adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.71-0.94; P = 0.004) and significantly lower severe disability at discharge (20.3% vs 33.8%, adjusted OR, 0.55; 95% CI, 0.44-0.69; P < 0.001) than level II centers. Subgroup analysis showed that cardiovascular injuries (N = 2004) and grades IV-V liver injuries (N = 1415) had a significantly better survival in level I than level II trauma centers (adjusted P = 0.017 and 0.023, respectively). Overall, there was a significantly better functional outcome in level I centers (adjusted P < 0.001). Subgroup analysis showed level I centers had significantly better functional outcomes in complex pelvic fractures (P < 0.001) and a trend toward better outcomes in the rest of the subgroups. The volume of trauma admissions with ISS >15 (<240 vs > or =240 cases per year) had no effect on outcome in either level I or II centers. CONCLUSIONS: Level I trauma centers have better outcomes than lower-level centers in patients with specific injuries associated with high mortality and poor functional outcomes. The volume of major trauma admissions does not influence outcome in either level I or II centers. These findings may have significant implications in the planning of trauma systems and the billing of services according to level of accreditation.

Adolescent↗
PubMed1996

Factors that enhance continued trauma center participation in trauma systems.

OBJECTIVES: To examine hospital, trauma system, and reimbursement factors that offset the financial burdens of trauma care delivery and to assess how proposed Medicaid and Medicare budget cuts may affect the ability of hospitals to alleviate financial pressures related to trauma care delivery. DESIGN AND SETTING: In-depth interviews and data collection for trauma centers in 12 metropolitan areas with populations of 1 million or more. PARTICIPANTS: Seventy trauma centers in these large urban communities that indicated a continuing commitment to providing trauma services for the foreseeable future. MAIN OUTCOME MEASURES: Hospital, trauma system, and reimbursement characteristics that distinguish hospitals that are better able to alleviate the financial burdens of indigent trauma care and a financial analysis that assesses payment adequacy for different payers and overall financial outcomes. DATA SOURCES: Data from a variety of sources were obtained to measure the factors that affect the operation and financing of trauma centers: published and unpublished hospital data from the American Hospital Association; trauma center level, length of operation, and the availability of alternative centers from a recently published study; Health Care Financing Administration data on Medicare and Medicaid program characteristics; automobile insurance requirements; and patient discharge data. Most data are reflective of 1992. RESULTS: Public hospitals, teaching hospitals, and institutions receiving supplemental indigent care payments appear to be best able to mitigate the financial burdens of uncompensated trauma care, especially those with moderate indigent care loads. A detailed financial analysis found that private hospitals with trauma centers were near break-even in 1992 for trauma care delivery and public hospitals experienced financial losses. Proposals to reduce Medicaid and Medicare would create substantial reductions in hospital payments for hospital-wide patient care and trauma patients specifically. CONCLUSION: Proposed Medicaid and Medicare payment cuts are likely to eliminate the delicate financial balance that many urban hospitals have achieved in providing trauma care. The erosion in funding from public programs may portend a new wave of trauma center closures as hospitals seek to deal with reduced reimbursement by eliminating unprofitable services.

Diagnosis-Related Groups↗
PubMed1997

[Trauma center 2000. How many and which trauma centers does Europe need around the year 2000?].

The treatment of severely injured patients is a challenge for preclinical and clinical treatment concepts, causing financial aspects of increasing importance for the German health care system. A total of 32,500 polytraumatized patients (PTS III and IV) are managed in trauma center levels I-IV in Germany. Trauma center levels I or II are by definition capable of supporting the full range of treatment for the severely injured. With the baseline calculation of 64,000 DM per patient and 104 polytrauma treated per year in the Berlin Virchow Clinic, 6.66 million DM primary costs must be spent for treatment. The total annual costs of this center are nearly 24 million DM for emergency cases and 7 million DM fixed costs per year, for a trauma center level I. In Europe the distribution of trauma center levels I or II is sufficient and can be specified with 1 center per 1 million inhabitants. Nevertheless, the european air medical service could support more intensive use of these central trauma institutions. This was shown by comparing the number of polytrauma patients and the number of trauma centers. Less then half of these patients are treated in levels I or II trauma centers. The financial pressure on the health system and the rising quality must lead to better utilization of trauma centers. To meet this goal a annual treatment rate of 300-400 polytrauma patients should be aimed at. The claim of the American College of Surgeons that a trauma surgeon should treat 50 severely injured patients per year would then be possible.

Cost-Benefit Analysis↗
PubMed2003

National inventory of hospital trauma centers.

CONTEXT: Trauma centers benefit thousands of injured individuals every day and play a critical role in responding to disasters. The last full accounting of the number and distribution of trauma centers identified 471 trauma centers in the United States in 1991. OBJECTIVE: To determine the number and configuration of trauma centers and identify gaps in coverage. DESIGN, SETTING, AND SUBJECTS: Interviews with trauma center directors (September 2001 to April 2002), data from the American Hospital Association's Annual Survey of Hospitals (2000), and the US Health Resources Administration's Area Resource File (2001) were used to determine characteristics of trauma center hospitals and the geographic areas they serve in all 50 states and in the District of Columbia. Characteristics of trauma centers were examined by level of care and compared with nontrauma centers. Hospitals are designated or certified as trauma centers by a state or regional authority or verified as trauma centers by the American College of Surgeons Committee on Trauma. Trauma centers that treat only children (n = 31) were excluded. MAIN OUTCOME MEASURE: Total number of trauma centers and number of trauma centers per million population. RESULTS: In 2002, there were 1154 trauma centers in the United States, including 190 level I centers and 263 level II centers. Several states have categorized every hospital with an emergency department at some level of trauma care while others have designated a limited number of level I and level II centers only. The number of level I and II centers per million population ranges from 0.19 to 7.8 by state. When compared with nontrauma center hospitals, trauma centers are larger, more likely to be teaching hospitals, and more likely to offer specialized services. CONCLUSIONS: Although the availability of trauma centers has improved, challenges remain to ensure the optimal number, distribution, and configuration of trauma centers. These challenges must be addressed, especially in light of the recent emphasis on hospital preparedness and homeland security.

Health Care Surveys↗
PubMed1995

An evaluation of patient outcomes before and after trauma center designation using Trauma and Injury Severity Score analysis.

In June 1990, the Ministry of Health designated 11 hospitals throughout Ontario to be lead hospitals in trauma care. An integral part of a trauma system is the evaluation of care, in particular, outcome of the trauma patients. The Trauma and Injury Severity Score (TRISS) methodology, which offers a standard approach for evaluating outcomes for different populations of trauma patients, was used to determine if there was an improvement in outcomes after the designation of trauma centers of patients involved in motor vehicle crashes (ICD-9-CM, E810.0-825.9), with an Injury Severity Score > 12 for two 12-month periods: one predesignation (1989/1990) and one postdesignation (1992/1993). The Revised Trauma Score, Injury Severity Score, age, and outcome were calculated or abstracted from the hospital chart of each patient at the trauma center. The probability of survival of each patient, the z- and W-statistics of both years were calculated. A measurable improvement was shown in z-statistics between the 2 years from z = -0.40 predesignation to z = +0.72 postdesignation. When the bias introduced by patients intubated before arrival at the trauma center being excluded from TRISS analysis was removed, using a TRISS-like (as per Offner et al: J. Trauma 32:32, 1992) logistic regression equation that allows analysis of intubated patients, the improvement was even greater, with z = +1.34 predesignation and z = +2.97 postdesignation. Only the statistically significant z-score of the postdesignated year required the W-score to be calculated, W = +5.60.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed2005

Physiologic trauma triage criteria in adult trauma patients: are they effective in saving lives by transporting patients to trauma centers?

BACKGROUND: Trauma triage criteria have been in place for many years and were updated in 1999 by the American College of Surgeons. We are unaware of any studies that have directly examined the ability of these criteria to reduce short-term mortality by transporting patients to trauma centers rather than to noncenters. STUDY DESIGN: Retrospective observational cohort study of adult patients meeting physiologic triage criteria who were transported to 9 regional (Level I) trauma centers, 21 area (Level II) trauma centers, and 119 noncenters in New York in 1996 to 1998. For each triage criterion and for one or more of the criteria, odds ratios and their confidence intervals for mortality in regional and area trauma centers versus noncenters and odds ratios and their confidence intervals for mortality in regional centers versus area centers and noncenters were used to measure performance. RESULTS: Patients in regional trauma centers had considerably lower mortality than patients in area trauma centers and noncenters for two individual triage criteria and for patients with one or more triage criteria (odds ratio, 0.75; 95% CI, 0.63-0.90 for one or more criteria). Also, patients with head injuries who were treated in regional centers had notably lower mortality than patients in other hospitals (odds ratio, 0.67; 95% CI, 0.53-0.85). CONCLUSIONS: In New York, regional trauma centers exhibit considerably lower mortality than area trauma centers or noncenters for adult patients meeting specific physiologic triage criteria. It is important that population-based trauma systems with data from centers and noncenters be developed for the purpose of evaluating and redesigning trauma systems.

Adolescent↗
PubMed2001

Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry.

BACKGROUND: Pediatric trauma centers (PTCs) were developed to improve the survival of injured children, but it is currently unknown if children admitted to PTCs are more likely to survive than those admitted to adult trauma centers (ATCs). METHODS: Fifty-three thousand one hundred thirteen pediatric trauma cases from 22 PTCs and 31 ATCs included in the National Pediatric Trauma Registry were reviewed to evaluate survival rates at PTCs and ATCs. RESULTS: Overall, 1,259 children died. The raw mortality rate was lower at PTCs (1.81% of 32,554 children) than at ATCs (3.88% of 18,368 children). However, patients admitted to ATCs were more severely injured. When Injury Severity Score, Pediatric Trauma Score, mechanism (blunt or penetrating), gender, age, clustering, and American College of Surgeons (ACS) verification status were controlled for using a single logistic regression model, there was no statistically significant difference in survival between PTCs and ATCs (odds ratio, 1.02; 95% confidence interval, 0.83-1.26; p = 0.587). A similar comparison of the 12 ACS-verified trauma centers with the 41 nonverified centers showed verification to be associated with improved survival (odds ratio, 0.75; 95% confidence interval, 0.58-0.97; p = 0.013). CONCLUSION: Although PTCs have higher overall survival rates than ATCs, this difference disappears when the analysis controls for Injury Severity Score, Pediatric Trauma Score, age, mechanism, and ACS verification status. ACS-verified centers have significantly higher survival rates than do unverified centers.

Adult↗
PubMed1991

Trauma center closure: effects on an adjacent trauma center.

The effects of the closure of a busy trauma center on an adjacent university trauma hospital were analyzed. Significant increases were found in monthly volume (P less than .01) and frequency of penetrating injuries (P less than .05) and significant decreases in patients with insurance coverage (P less than .01) and numbers requiring intensive care (P less than .01). The authors conclude that trauma center closures have significant and measurable effects which influence allocation of scarce resources within remaining hospitals and generate pressures to transfer patients to overburdened public facilities. Transfers undermine continuity of care and education and further threaten the integrity of the trauma system.

Health Facility Closure↗