Impact of establishing a level-1 trauma center for lower extremity trauma: a 4-year experience

Abstract

Purpose A multidisciplinary approach is essential for trauma patients’ treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures. Methods A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice. Results Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 ± 17.48 to 11.65 ± 19.33 h post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. Conclusion With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients’ quality of life.

Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review

“…[22][23][24][25][26][27][28] All studies reported a pre and post-trauma system implementation comparison. Three articles reported all trauma patient types, 22 23 27 two articles reported on patients with traumatic brain injury (TBI), 24 25 one article reported on lower limb open fracture patients, 26 and one article reported on penetrating thoracic trauma patients. 28 In total, 17 137 patients were included across all studies (table 1).…”

“…A study from Suwon, South Korea, also reported morbidity outcomes, describing the impact of their regional trauma system implementation on trauma patients who suffered an open fracture below the knee and with Gustilo-Anderson classification type II or type III and rates of limb salvage. 26 Limited details were provided on the specific trauma system implemented, although trauma system care in South Korea has previously been well described. Limb salvage was defined as the resolution of soft tissue wounds without a requirement for major amputation.…”

“…Three studies were identified that reported specific morbidity outcomes. [26][27][28] A study from the West Midlands, United Kingdom (UK), evaluated the implementation of a regional trauma system in 2012, assessing its impact on patients achieving a 'good recovery', which was defined as patients being discharged home to live independently, with no new arrangements for domiciliary care. 27 The implementation of the trauma system showed a significant increase in the proportion of patients having a good recovery, from 55.5% to 62.3% (p<0•001).…”