Relationship Between American College of Surgeons Trauma Center Designation and Mortality in Patients with Severe Trauma (Injury Severity Score > 15)

Department of Surgery, Division of Trauma and Surgical Critical Care, School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Journal of the American College of Surgeons (Impact Factor: 5.12). 03/2006; 202(2):212-5; quiz A45. DOI: 10.1016/j.jamcollsurg.2005.09.027
Source: PubMed


We studied the association of the American College of Surgeons (ACS) trauma center designation and mortality in adult patients with severe trauma (Injury Severity Score > 15). ACS designation of trauma centers into different levels requires substantial financial and human resources commitments. There is very little work published on the association of ACS trauma center designation and outcomes in severe trauma.
National Trauma Data Bank study including all adult trauma admissions (older than 14 years of age) with Injury Severity Score (ISS) > 15. The relationship between ACS level of trauma designation and survival outcomes was evaluated after adjusting for age, mechanism of injury, ISS, hypotension on admission, severe liver trauma, aortic, vena cava, iliac vascular, and penetrating cardiac injuries.
A total of 130,154 patients from 256 trauma centers met the inclusion criteria. Adjusted mortality in ACS-designated Level II centers and undesignated centers was notably higher than in Level I centers (adjusted odds ratio, 1.14; 95% CI, 1.09-120; p < 0.0001 and adjusted odds ratio, 1.09; CI, 1.05-1.13; p < 0.0001, respectively).
Severely injured patients with ISS > 15 treated in ACS Level I trauma centers have considerably better survival outcomes than those treated in ACS Level II centers.

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    • "In the United States, injury is the leading cause of death, killing more people ages 1 to 44 years than any other cause, and costing more than $406 billion annually in medical care [1] [2]. In the past 4 decades, the American College of Surgeons Committee on Trauma (ACS-COT), the Institute of Medicine, and federal and state governments have promoted regionalized trauma care as the best approach for matching patient needs with the available resources and provider expertise to achieve optimal patient outcomes [3] [4] [5] [6]. Within an ideal organized trauma system, patients with severe injuries should receive definitive care at level I or II trauma centers (TCs), whereas those with minor injuries should receive care at nontrauma centers (NTCs) or level III TCs [7]. "
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    ABSTRACT: Background There is evidence that regionalized trauma care and appropriate triage of major trauma patients improve patient outcomes. However, the national rate of undertriage and diagnoses of undertriaged patients are unknown. Methods We used the 2010 Nationwide Emergency Department Sample (NEDS) to estimate the national rate of undertriage, identify the prevalent diagnoses, and conduct a simulation analysis of the capacity increase required for level I and II trauma centers to accommodate undertriaged patients. Undertriaged patients were those with major trauma, Injury Severity Score (ISS) ≥ 16, who received definitive care at nontrauma centers (NTC) or level III trauma centers. The rate of undertriage was calculated with those receiving definitive care at a NTC center or level III center as a fraction of all major trauma patients. Results The estimated number of major trauma patient discharges in 2010 was 232,448. Level of care was known for 197,702 major trauma discharges and 34.0% were undertriaged in emergency departments. Elderly patients were at a significantly higher risk of being undertriaged. Traumatic brain injury (TBI) was the most common diagnosis, 40.2 % of the undertriaged patient diagnoses. In order to accommodate all undertriaged patients, level I and II trauma centers nationally would have to increase their capacity by 51.5%. Conclusions We found that over 1/3 of U.S. ED major trauma patients were undertriaged and more than 40% of undertriaged diagnoses were TBIs. A significant capacity increase at Level I and II trauma centers to accommodate these patients appears not feasible.
    American Journal of Emergency Medicine 09/2014; 32(9). DOI:10.1016/j.ajem.2014.05.038 · 1.27 Impact Factor
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    • "It is reported that mortality decreases when patients are treated on scene by a physician in conjunction with a nurse [33,34]. Transportation of a severely injured trauma patient to a level 1 trauma centre is in line with the current international standards [9,32,35,36]. In contrast, the establishment of a provisional diagnosis is, as far as we know, never mentioned and/or investigated as a relevant aspect of trauma care. "
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    ABSTRACT: Background In organised trauma systems the process of care is the key to quality. Nevertheless, the optimal process of trauma care remains unclear due to lack of or inconclusive evidence. Because monitoring and improving the performance of a trauma system is complex, this study aimed to develop consensus-based process guidelines for trauma care in the Netherlands for severely injured patients. Methods A five-round Delphi study was conducted with 141 participants that represent all professions involved in trauma care. Sensitivity analyses were carried out to evaluate whether consensus extended across all professions and to detect possible bias. Results Consensus was reached on 21 guidelines within 4 categories: timeliness, actions, competent teams and interdisciplinary process. Timeliness guidelines set specific critical limits and definitions for 10 time intervals in the time period from an emergency call until the patient leaves the trauma room. Action guidelines reflect aspects of appropriate care and strongly rely on the international Advanced Trauma Life Support principles. Competence guidelines include flow charts to assess the competence of prehospital and emergency department teams. Essential to competent teams are education and experience of all team members. The interdisciplinary process guideline focuses on cooperation, communication and feedback within and between all professions involved. Consensus was extended across all professions and no bias was detected. Conclusions In this Delphi study, a large expert panel agreed on a set of guidelines describing the optimal process of care for severely injured trauma patients in the Netherlands. In addition to time intervals and appropriate actions, these guidelines emphasise the importance of team competence and interdisciplinary processes in trauma care. The guidelines can be seen as a description of a best practice and a new field standard in the Netherlands. The next step is to implement the guidelines and monitor the performance of the Dutch trauma system based on the guidelines.
    BMC Health Services Research 03/2013; 13(1):79. DOI:10.1186/1472-6963-13-79 · 1.71 Impact Factor
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    ABSTRACT: Chest injury is a relative frequent situation and may result in respiratory and/or hemodynamic failure. Major etiologies are penetrating or blunt trauma. In 30% of cases, chest lesions are associated with multiple trauma. Initial evaluation in the emergency room is a challenging issue. Based of the relevant literature and their known experience, authors define the management of a chest trauma patient with a special emphasis for priorities of diagnostic procedure, chest tube and surgical indication. Initial chest injury management requires strict adherence to advanced trauma life support. Cooperation between surgeon, anaesthesiologist and emergency physician in diagnostic and treatment of these trauma is a condition for successful results.
    Réanimation 12/2006; 15(s 7–8). DOI:10.1016/j.reaurg.2006.10.010
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