Survival of the Fittest: The Hidden Cost of Undertriage of Major Trauma

Haas, Barbara; Gomez, David; Zagorski, Brandon; Stukel, Thérèse A.; Rubenfeld, Gordon D.; Nathens, Avery B.

doi:10.1016/j.jamcollsurg.2010.08.014

Cited by 168 publications

(146 citation statements)

References 29 publications

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“…15,16 Patients who had injuries due to the following conditions were excluded: late effects (905-909); superficial injuries (910-924); foreign bodies (930-939); burns (940-949). 17 The NTDB contains variables describing the different transportation modes (ground versus helicopter versus fixed-wing ambulance), in addition to non-EMS transportation modes (private or public vehicle or walk-in, police). We included patient demographics, insurance status and the following injury characteristics: injury mechanism, injury type (penetrating vs. blunt) and injury severity.…”

Section: Data Source and Study Populationmentioning

confidence: 99%

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Corrado

Shi

Wheeler

et al. 2017

The American Journal of Emergency Medicine

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Objectives-This study aimed to assess the proportions of injured children transported to trauma centers by different transportation modes and evaluate the effect of transportation mode on interfacility transfer rates using the U.S. national trauma registry.Methods-We analyzed data from the 2007-2012 National Trauma Data Bank (NTDB) to study trends of EMS versus non-EMS transport. Multivariable logistic regression was used to evaluate the association between transport mode and inter-facility transfer.Results-There were 286,871 pediatric trauma patients in the 2007-2012 NTDB; 45.8% arrived by ground ambulance, 8.6% arrived by air ambulance, and 37.5% arrived by non-EMS. From 2007-2012, there was no significant change among each transportation mode. Moderate to severely injured patients (ISS>15) comprised 13.3% of arrivals by ground ambulance, 26.7% of arrivals by air ambulance, and 8.3% of arrivals by non-EMS; those who used EMS were significantly less likely to be transferred to another facility than patients who used non-EMS transport. Moderate and severe pediatric patients arriving by non-EMS to adult trauma centers were more often transferred than those arriving at mixed trauma centers (45.8% and 6.8%, respectively).Conclusions-Over one third of US pediatric trauma patients used non-EMS transport to arrive at trauma centers. Moderate to severely injured children benefit from EMS transport and

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Section: Data Source and Study Populationmentioning

confidence: 99%

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Corrado

Shi

Wheeler

et al. 2017

The American Journal of Emergency Medicine

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“…A retrospective study conducted by Haas et al showed that 30% of injured patients admitted to their trauma center were transferred from another facility. 29 …”

Section: Adult Transportmentioning

confidence: 99%

Inter- and Intra-hospital Transport of the Critically IllDiscussion

Blakeman

Branson

2013

Respir Care

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Intra-and inter-hospital transport is common due to the need for advanced diagnostics and procedures, and to provide access to specialized care. Risks are inherent during transport, so the anticipated benefits of transport must be weighed against the possible negative outcome during the transport. Adverse events are common in both in and out of hospital transports, the most common being equipment malfunctions. During inter-hospital transport, increased transfer time is associated with worse patient outcomes. The use of specialized teams with the transport of children has been shown to decrease adverse events. Intra-hospital transports often involve critically ill patients, which increases the likelihood of adverse events. Radiographic diagnostics are the most common in-hospital transport destination and the results often change the course of care. It is recommended that portable ventilators be used for transport, because studies show that use of a manual resuscitator alters blood gas values due to inconsistent ventilation. The performance of new generation transport ventilators has improved greatly and now allows for seamless transition from ICU ventilators. Diligent planning for and monitoring during transport may decrease adverse events and reduce risk.

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“…25 However, the use of more inclusive trauma systems appears to mitigate these effects. 26 This mitigation is probably the result of having lower-level centers ready to resuscitate patients and initiate treatment of major injuries, as well as broad acceptance of systemwide protocols that expedite transfer when appropriate.…”

Section: Costs and Benefits Of Trauma Systemsmentioning

confidence: 99%

Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To Patient Health Care Needs

2013

Self Cite

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Trauma systems provide an organized approach to the care of injured patients within a defined geographic region. When fully operational, the systems ensure a continuum of care involving public access through 911 calls, emergency medical services, timely triage and transport to acute care, and transfer to rehabilitation services. Substantial progress has been made in establishing statewide trauma systems, which are seen as the prototype for regionalized care for other time-sensitive, emergency conditions such as stroke. Trauma systems provide a model of care that is consistent with the goals of the Affordable Care Act, which authorizes $100 million in annual grants to ensure the continued availability of trauma services. Full funding of these provisions is needed to stabilize statewide systems that are struggling to survive. We describe the components of a regionalized trauma system, review the evidence in support of this approach, and discuss the challenges to sustaining systems that are accountable and affordable.

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Survival of the Fittest: The Hidden Cost of Undertriage of Major Trauma

Cited by 168 publications

References 29 publications

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Inter- and Intra-hospital Transport of the Critically IllDiscussion

Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To Patient Health Care Needs

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