Article

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: 4.45). 03/2006; 202(2):212-5; quiz A45. DOI: 10.1016/j.jamcollsurg.2005.09.027
Source: PubMed

ABSTRACT 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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    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.
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