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Survival rates appear to differ among level I trauma centers
February 19, 2008Trauma centers designated as level I may have significantly different results when treating patients with similar injuries, according to a report in the February issue of Archives of Surgery, one of the JAMA/Archives journals.
"Decades of concerted efforts by trauma professionals and patient advocacy groups have led to the development of trauma centers in most states," the authors write as background information in the article. "A critical component of these systems is the use of explicit criteria for the availability of personnel, equipment and services through the process of trauma center verification by the American College of Surgeons (ACS)." These criteria are based on structures and processes deemed essential for providing the best care.
Shahid Shafi, M.D., M.P.H., and colleagues at the University of Texas Southwestern Medical School, Dallas, analyzed data from 211,479 patients admitted to 47 level I trauma centers between 1999 and 2003. The patients were divided into three groups based on the severity of their injuries, assessed by a number of measures such as blood pressure and the presence or absence of shock. The average percentage of patients who survived was calculated for all trauma centers; survival rates from individual centers were then compared to this average.
The average survival rate was 99 percent for patients with mild injuries, 75 percent for those with moderate injuries and 35 percent for those with severe injuries. "For mild injuries, survival at five centers (11 percent) was significantly worse than that at their counterpart centers," the authors write. "With increasing injury severity, the percentages of outcome disparities increased (15 percent of centers for moderate injuries and 21 percent of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries and older (more than 55 years) individuals."
"These variations in outcomes may represent a substantial quality chasm in the delivery of trauma care," they continue. It is possible that the verification process may not specify all resources needed to provide optimal care, the authors note. For example, one previous study showed that the presence of a trauma and surgical critical care fellowship program improved outcomes at level I trauma centers, though it is not a criterion required for verification.
In addition, having all the necessary resources does not ensure they will be deployed adequately. "If confirmed, our preliminary data suggest that the logical next step for the trauma community is to move beyond focusing on personnel and processes and to start focusing on the outcomes achieved by the use of those resources," the authors conclude.
JAMA and Archives Journals
The average survival rate was 99 percent for patients with mild injuries, 75 percent for those with moderate injuries and 35 percent for those with severe injuries. "For mild injuries, survival at five centers (11 percent) was significantly worse than that at their counterpart centers," the authors write. "With increasing injury severity, the percentages of outcome disparities increased (15 percent of centers for moderate injuries and 21 percent of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries and older (more than 55 years) individuals."
"These variations in outcomes may represent a substantial quality chasm in the delivery of trauma care," they continue. It is possible that the verification process may not specify all resources needed to provide optimal care, the authors note. For example, one previous study showed that the presence of a trauma and surgical critical care fellowship program improved outcomes at level I trauma centers, though it is not a criterion required for verification.
In addition, having all the necessary resources does not ensure they will be deployed adequately. "If confirmed, our preliminary data suggest that the logical next step for the trauma community is to move beyond focusing on personnel and processes and to start focusing on the outcomes achieved by the use of those resources," the authors conclude.
JAMA and Archives Journals
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National study finds post-traumatic stress disorder common among injured patients
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National study finds post-traumatic stress disorder common among injured patients
Suffering a traumatic injury can have serious and long-lasting implications for a patient's mental health, according to the largest-ever U.S. study evaluating the impact of traumatic injury.
Elderly patients less likely to be transported to trauma centers than younger patients
Elderly trauma patients appear to be less likely than younger patients to be transported to a trauma center, possibly because of unconscious age bias among emergency medical services personnel.
Survey compares views of trauma professionals, the public on dying from injuries
Most trauma professionals and members of the general public say they would prefer palliative care following a severe injury if physicians determined aggressive critical care would not save their lives, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
Teens underestimate risk, overestimate vehicle, highway safety in motor vehicle accidents
Most teens' attitudes regarding trauma-related injuries, particularly those due to motor vehicle crashes, reflect an sense of invincibility and focus on fate rather than choice, according to new research published in the August issue of the Journal of the American College of Surgeons.
Widespread airbag use could result in dramatic cost savings for US trauma centers
According to research published in the May issue of the Journal of the American College of Surgeons, the new generation of airbags not only helps protect motor vehicle collision (MVC) victims from injury and death, but also are associated with dramatic cost saving to trauma centers.
Excessive overtriage in US trauma centers overwhelming system resources, delaying patient care
Research in the January issue of the Journal of the American College of Surgeons (JACS) shows that many patients with minimal injuries are being transferred from community hospitals to Level I and II trauma centers, despite the ability of the community hospitals to treat such injuries.
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