The Effect of Trauma Center Designation and Trauma Volume on Outcome in Specific Severe Injuries

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

doi:10.1097/01.sla.0000184169.73614.09

Cited by 354 publications

(237 citation statements)

References 20 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: 87%

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: 87%

Facility Characteristics and Inhospital Pediatric Mortality after Severe Traumatic Brain Injury

Mills

Rowhani-Rahbar

Vavilala

2015

Journal of Neurotrauma

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“…It is interesting that only 17.7% of the patients had an isolated abdominal injury. However, majority of the patients with abdominal trauma present with thoracic and/or pelvic injuries, [6][7][8] indicating that the management of patients with blunt trauma injuries requires a multidisciplinary approach, including physicians trained in the management of trauma, as well as well-equipped trauma centers. The mortality rate has been reported to be lower in healthcare centers where trauma management is satisfactory.…”

Section: Discussionmentioning

confidence: 99%

“…It is also the major cause of death in individuals aged 5 to 49 sicians and other healthcare staff trained on the management of trauma injuries is available. [6,7] In Turkey, general surgeons are still mostly faced with patients with multi-trauma injuries in State Hospitals, University Hospitals, and Training and Research Hospitals, followed by the request for consultation. These patients may be referred to the related department for additional therapies when their clinical status is stable.…”

Section: Introductionmentioning

confidence: 99%

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Özpek

Yücel

Atak

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…1 In the past 4 decades, regionalized trauma care has been promoted in the U.S. as the best approach for matching patient needs with the available resources and provider expertise to achieve optimal patient outcomes. [2][3][4][5] Previous research has shown that trauma centers achieve better outcomes among severely injured patients than non-trauma centers; however, it has been found that about one-third of patients with severe injuries were treated at nontrauma centers or level III trauma centers. 3,6 Transportation to the hospital via Emergency Medical Service (EMS) is important in caring for trauma patients for several reasons.…”

Section: Introductionmentioning

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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The Effect of Trauma Center Designation and Trauma Volume on Outcome in Specific Severe Injuries

Cited by 354 publications

References 20 publications

Facility Characteristics and Inhospital Pediatric Mortality after Severe Traumatic Brain Injury

Facility Characteristics and Inhospital Pediatric Mortality after Severe Traumatic Brain Injury

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

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

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