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

Δημητριάδης, Δημήτριος; Martin, Matthew J.; Salim, Ali; Rhee, Peter; Brown, Chelsea; Doucet, Jay; Chan, Linda S.

doi:10.1016/j.jamcollsurg.2005.09.027

Cited by 226 publications

(149 citation statements)

References 7 publications

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“…Using National Trauma Data Bank (NTDB) data from 1994-2003, one group found significantly lower mortality among patients age 14 or older treated for severe traumatic injuries at Level I trauma centers compared with patients treated at Level II centers. 8,9 These findings were consistent with several smaller, state-specific studies, which found significantly lower risk of mortality among all adult trauma patients treated at Level I centers in Pennsylvania 10 and Ohio 11 compared with those treated at Level II centers. Conversely, one study focused on isolated patients with severe TBI of all ages in the NTDB found no significant difference in mortality between American College of Surgeons (ACS) Level I and II trauma centers.…”

Section: Introductionsupporting

confidence: 86%

Facility Characteristics and Inhospital Pediatric Mortality after Severe Traumatic Brain Injury

Mills

Rowhani-Rahbar

Vavilala

2015

Journal of Neurotrauma

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More than 500,000 children sustain a traumatic brain injury (TBI) each year. Previous studies have described significant variation in inhospital mortality after pediatric TBI. The aim of this study was to identify facility-level characteristics independently associated with 30-day inhospital mortality after pediatric severe TBI. We hypothesized that, even after accounting for patient-level characteristics associated with mortality, the characteristics of facilities where patients received care would be associated with inhospital mortality. Using data from the National Trauma Data Bank from 2009-2012, we identified a cohort of 6707 pediatric patients hospitalized with severe TBI in 391 facilities and investigated their risk of 30-day inhospital mortality. Pre-specified facility-level characteristics (trauma certification level, teaching status, census region, facility size, nonprofit status, and responsibility for pediatric trauma care) were added to a Poisson regression model that accounted for patient-level characteristics associated with mortality. In multivariable analyses, patients treated in facilities located in the Midwest (risk ratio [RR] = 1.42; 95% confidence interval [CI] 1.12-1.81) and South (RR = 1.39; 95% CI: 1.12-1.72) regions had higher likelihoods of 30-day inhospital mortality compared with patients treated in the Northeast. Other facility-level characteristics were not found to be significant. To our knowledge, this is one of the largest investigations to identify regional variation in inhospital mortality after pediatric severe TBI in a national sample after accounting for individual and other facility-level characteristics. Further investigations to help explain this variation are needed to inform evidence-based decision-making for pediatric severe TBI care across different settings.

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Section: Introductionsupporting

confidence: 86%

Facility Characteristics and Inhospital Pediatric Mortality after Severe Traumatic Brain Injury

Mills

Rowhani-Rahbar

Vavilala

2015

Journal of Neurotrauma

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“…20 In trauma research, the ISS also has been used to dichotomize trauma patients into severe injuries (ISS ≥15) and nonsevere injuries (ISS <15) and to evaluate the outcomes of patients with similar degrees of injury severity. 21,22 To more closely correspond with outcome, a physiologic injury severity scoring system such as the RTS was used in addition to the anatomic classification of injury severity. The RTS has been shown to be associated with survivability and is used in trauma research for outcome evaluations and to control for injury.…”

Section: Methodsmentioning

confidence: 99%

Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services

Sullivent

Faul

Wald

2011

Prehospital Emergency Care

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Background. Some studies have shown improved outcomes with helicopter emergency medical services (HEMS) transport, while others have not. Safety concerns and cost have prompted reevaluation of the widespread use of HEMS. Objective. To determine whether the mode of transport of trauma patients affects mortality. Methods. Data for 56,744 injured adults aged ≥18 years transported to 62 U.S. trauma centers by helicopter or ground ambulance were obtained from the National Sample Program of the 2007 National Trauma Data Bank. In-hospital mortality was calculated for different demographic and injury severity groups. Adjusted odds ratios (AOR) were produced by utilizing a logistic regression model measuring the association of mortality and type of transport, controlling for age, gender, and injury severity (Injury Severity Score [ISS] and Revised Trauma Score [RTS]). Results. The odds of death were 39% lower in those transported by HEMS compared with those transported by ground ambulance (AOR = 0.61, 95% confidence interval [CI] = 0.54-0.69). Among those aged ≥55 years, the odds of death were not significantly different (AOR = 0.92, 95% CI = 0.74-1.13). Among all transports, male patients had a higher odds of death (AOR = 1.23, 95% CI = 1.10-1.38) than female patients. The odds of death increased with each year

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“…Injury treatment at designated trauma centers can reduce mortality from traumatic injury, [1][2][3][4] but the majority of US residents in rural areas do not have timely access to Level I or II trauma centers. 5 Geographic barriers to trauma care are more likely to impact racial minorities and people living in poverty, 6 paralleling established racial and socioeconomic disparities in trauma mortality.…”

Section: Introductionmentioning

confidence: 99%

Rural risk: Geographic disparities in trauma mortality

Jarman

Castillo

Carlini

et al. 2016

Surgery

125

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

Cited by 226 publications

References 7 publications

Facility Characteristics and Inhospital Pediatric Mortality after Severe Traumatic Brain Injury

Facility Characteristics and Inhospital Pediatric Mortality after Severe Traumatic Brain Injury

Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services

Rural risk: Geographic disparities in trauma mortality

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