Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers

Vickers, Brian P.; Shi, Junxin; Lü, Bo; Wheeler, Krista K.; Peng, Jin; Groner, Jonathan I.; Haley, Kathryn J.; Xiang, Hao

doi:10.1016/j.ajem.2015.05.010

Cited by 14 publications

(7 citation statements)

References 25 publications

(35 reference statements)

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“…Several authors have demonstrated that undertriaged patients tend to have worse outcomes than appropriately triaged patients,9–11 including increased mortality 12,13. Hence, the ACS encourages the trauma centers to achieve an undertriage rate less than 5%.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Barsi

Harris

Menaik

et al. 2016

OAEM

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PurposeThe primary objective of this study was to determine the risk factors associated with undertriage and the risk factors for mortality among the undertriaged patients at a level I safety-net trauma center.MethodsA retrospective analysis was performed of all trauma patients who presented to a level I safety-net trauma center with an injury severity score >15 over a 2-year period (2013–2014). Univariate and multivariate regression analyses were used to determine the risk factors predictive of undertriage in major trauma patients (injury severity score >15) and of mortality in undertriaged patients.ResultsDuring the 2-year study period, 334 of 2,485 admitted trauma patients presented with major trauma and were included in our study. From the univariate analysis, variables that were found to be independently associated with mortality in undertriaged patients included intubation, Glasgow Coma Scale score, revised trauma score, and dementia. Independent risk factors that were found to be significantly associated with undertriage in severely injured trauma patients included Glasgow Coma Scale score, motor vehicle crash, falls, revised trauma score, systolic blood pressure, heart rate, intubation, and dementia. When a multivariate analysis was performed to evaluate the statistically significant risk factors, dementia was found to be significantly associated with undertriage in severely injured trauma patients.ConclusionSeverely injured trauma patients with dementia are at significant risk for undertriage. Early identification of these risk factors while triaging at a level I safety-net trauma center could translate into improved patient outcomes following severe trauma.

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Section: Introductionmentioning

confidence: 99%

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Barsi

Harris

Menaik

et al. 2016

OAEM

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“…2 However, the emergency department mortality of trauma patients at a national level has only recently been studied. 3 The emergency department mortality in different levels of trauma centers is important information for optimal utilization of medical resources. Our previous study showed that if major trauma patients treated in emergency departments of non-trauma centers or Level III trauma centers were triaged to Level I or II trauma centers, the capacity of trauma centers would have to be increased dramatically.…”

Section: Introductionmentioning

confidence: 99%

Unmeasured Confounding in Observational Studies with Multiple Treatment Arms

et al. 2016

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Comparing emergency department mortality across different levels of trauma care (nontrauma centers, level I and II centers) is important in evaluating regionalized care. Patient population characteristics differ across different levels of trauma care and it is essential to adjust for baseline covariates to make valid comparisons. Propensity score matching has been established as a more robust method to infer causal relationship in observational studies than conventional regression adjustment. We designed and implemented a three group matching methodology. First, we conducted optimal pair matching between the treatment group (nontrauma centers) and the first control group (level I trauma centers); second, we conducted optimal pair matching between the nontrauma centers and the second control group (level II trauma centers); the final step was to link the two sets of matched pairs by the common treatment subjects to form matched triplets. We then implemented a sensitivity analysis with three treatment arms, Lu's imputation based method, to assess the impact due to potential unmeasured confounding. The results showed that if the most severe adult trauma patients treated in nontrauma centers were to be treated in level I or II trauma centers, the odds of emergency department death would be reduced dramatically (odds ratio [OR] = 0.61 and 0.49). There was no difference between being treated in level I or II trauma centers. The sensitivity analysis revealed that the positive association between being treated at level I or II trauma centers and the reduced odds of mortality would remain present even in the presence of strong unmeasured confounding.

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“…On average, only 15% of victims of injuries of external causes need to be treated at Level I Trauma Centers (FRAGA, 2007), the highest of the four levels advocated by the American College of Surgeons (AMERICAN COLLEGE OF SURGEONS, 2006). A study comparing the results of severely injured patients treated in systems with Trauma Centers indicate a reduction in the mortality (CELSO ET AL., 2007;VICKERS ET AL., 2015). According to Fraga (2007), the reduction of preventable deaths reaches 50% in these systems.…”

Section: Introductionmentioning

confidence: 99%

Centro de Trauma: modelo alternativo de atendimento às causas externas no estado do Rio de Janeiro

Silveira

O’Dwyer

2017

Saúde debate

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The objective was to evaluate the Trauma Center of a public hospital in the state of Rio de Janeiro. As methodology the service was observed and indicators were analyzed, including: eligibility criteria; established procedures of service; number and causes of care; and length of stay. The service met the recommended protocols. The mean hospital stay was 11.4 days, similar to the rest of the network, despite the highly complex profile. Seventy-nine percent of the patients were from the prehospital setting and 54.97% were from traffic accidents. The mortality was 4.5%. The Trauma Center fulfilled goals and it is expected that the experience from this center will contribute to the construction of a state policy for trauma care. KEYWORDS

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Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers

Cited by 14 publications

References 25 publications

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Unmeasured Confounding in Observational Studies with Multiple Treatment Arms

Centro de Trauma: modelo alternativo de atendimento às causas externas no estado do Rio de Janeiro

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