The impact of a regionalized trauma system on trauma care in San Diego County

Guss, David A.; Meyer, F.; Neuman, Tom S.; Baxt, William G.; Dunford, James V.; Griffith, Lee D.; Guber, Steven L.

doi:10.1016/s0196-0644(89)80048-4

Cited by 90 publications

(16 citation statements)

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“…The suburban hospital could manage more severely injured patients with little transfer. Guss et al [8] reported that a regionalized trauma system on trauma care can improve the trauma outcomes. Although in Korea, trauma centers are developing as a form of specialized emergency center, EMC play a major role in acute trauma care in urban and suburban areas.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Trauma Outcome between Urban and Suburban Hospital

Choi¹,

Lee

Hong³

et al. 2006

Eur J Trauma

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This study compared the trauma outcome between urban and suburban hospitals. The medical records of patients admitted to the intensive care unit (ICU) following trauma, obtained from 1994 to 1995 and 2002 to 2003, were examined. One was a tertiary university teaching hospital with regional emergency medical center (EMC), and the other was a small general hospital in a suburban area. Since 1999, the suburban hospital has enlarged its capacities to include EMC. In this study, the standardizing W (Ws), 95% confidence interval (CI) of Ws, and the predicted survival rate (Ps) were calculated using the Trauma and Injury Severity Score (TRISS) method. From 1994 to 1995, 225 and 121 records of the urban and suburban hospital were reviewed, respectively. The performance of trauma care in the urban hospital was more accurate than that in the suburban (95% CI of the Ws in urban and small suburban hospital: -2.30 to 2.73 and -11.40 to -5.90, respectively). The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all revised trauma score (RTS). From 2002 to 2003, 315 and 268 medical records of urban and suburban hospital were reviewed, respectively. The 95% CI of the Ws in urban and suburban hospital was -3.56 to 0.24 and -3.73 to 0.26, respectively. In addition, there were no differences in the distribution of actual survival rate that was compared with the predicted survival rate according to injury severity score (ISS) and RTS in each hospital. After increasing the capacity of the suburban hospital, the trauma care performance was more accurate, and the ability of the physiologic support had improved. In addition, a larger suburban hospital could manage more severely injured patients without the need for transfer (mean ISS from 1994(mean ISS from -1995(mean ISS from to 2002(mean ISS from -2003.0 vs. 24.3, p = 0.059, mean RTS: 7.0 and 6.2, p = 0.003; transfer:admission ratio = 0.182:0.056, respectively, p = 0.01). In conclusion, under the wellconstructed emergency medical service system, the enlargement of the capacities of emergency and intensive care should improve the performance of trauma care in suburban hospital.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Trauma Outcome between Urban and Suburban Hospital

Choi¹,

Lee

Hong³

et al. 2006

Eur J Trauma

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“…67,127,136,140 Level of education and organization of trauma response teams may influence adverse events more so than geography and speed. Several studies have documented that critical care teams composed of physicians and trained nurses achieve better outcomes for patients with severe TBI.…”

Section: 63mentioning

confidence: 99%

Prehospital management of traumatic brain injury

Stiver¹,

Manley²

2008

FOC

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The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

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“…Local and regional trauma systems are effective in decreasing traumarelated morbidity and mortality. [17][18][19][20][21][22][23][24][25][26][27] Despite being based on similar principles, a number of important differences exist between the organization of trauma care and that of stroke care. These differences are such that simply designating trauma systems as stroke systems would be inappropriate.…”

Section: Application Of Systems Approaches To Other Emergency Conditionsmentioning

confidence: 99%