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PubMed1993

An analysis of the association of trauma centers with per capita hospitalizations and death rates from injury.

OBJECTIVE: This study used population-based data bases to assess the association of trauma centers with per capita county hospitalization and trauma death rates in the State of North Carolina. SUMMARY BACKGROUND DATA: The current study extended previous work using two North Carolina data bases to assess the association of the presence of a trauma center with per capita county trauma death rates. METHODS: Data on per capita county trauma hospitalizations and deaths were obtained from the state hospital discharge data base and the North Carolina Medical Examiner's data base. Bivariate and multivariate analysis techniques were used. The dependent variables of interest were prehospital, hospital, and total trauma death rates and hospitalization rates for injury. RESULTS: Bivariate analysis identified a number of factors associated with per capita county hospitalizations and trauma death rates. These included the per cent unemployment, racial distribution, county alcohol tax receipts, and advanced life support certified emergency medical services providers. The per capita trauma death rates were significantly lower in counties with trauma centers compared with those without trauma centers (4.0 +/- 0.5 and 5.0 +/- 1.1 deaths per 10,000 population, p = 0.0001, respectively). The per capita hospitalizations for trauma were also lower in counties with trauma centers. Multivariate modeling showed that the presence of a trauma center and advanced life support providers were the best predictors of decreased per capita county trauma death rates. CONCLUSIONS: The study showed that the presence of a trauma center and advanced life support training were the two medical system factors that were the best predictors of the per capita county prehospital and total trauma death rates. These findings are consistent with the hypothesis that trauma centers are associated with a decrease in trauma death rates.

Adolescent↗

PubMed1992

Open pelvic fracture: an injury for trauma centers.

Twenty-seven blunt trauma patients with open pelvic fracture who were seen in a trauma center over a 10-year period were characterized for treatment and resource consumption. Age, injury severity score, mortality, mechanism of injury, associated injuries, blood requirement, length of stay (LOS), surgical procedures, and complications were analyzed. There was a mean of 26 units of blood transfused, 9 operative procedures, and LOS of 43 days. Associated injuries were common. Aggressive hemorrhage and sepsis control, including 2 hemipelvectomies, resulted in an overall survival rate of 85%, with no mortality occurring in the last 20 patients. The reduced mortality obtained in the treatment of this highly resource consumptive injury suggests that open pelvic fracture should be managed at a trauma center, where these resources are immediately available.

Adult↗

PubMed2004

Injury prevention priority score: a new method for trauma centers to prioritize injury prevention initiatives.

BACKGROUND: Trauma centers are expected to develop injury prevention programs that address needs of the local population. A relatively simple, objective, and quantitative method is needed for prioritizing local injury prevention initiatives based on both injury frequency and severity. STUDY DESIGN: Pediatric trauma patients (16 years or younger; n= 7,958) admitted to two Level I regional trauma centers (Johns Hopkins Children Center and Westchester Medical Center) from 1993 to 1999 were grouped by injury causal mechanism according to ICD-9 external cause codes. An Injury Prevention Priority Score (IPPS), balancing the influences of severity (based on the Injury Severity Score) and frequency, was calculated for each mechanism and mechanisms were ranked accordingly. RESULTS: IPPS-based rank lists differed across centers. The highest ranked mechanism of injury among children presenting to Johns Hopkins Children Center was "pedestrian struck by motor vehicle," and at Westchester Medical Center it was "motor vehicle crash." Different age groups also had specific injury prevention priorities, eg, "child abuse" was ranked second highest among infants at both centers. IPPS was found to be stable (r = 0.82 to 0.93, p < 0.05) across alternate measures of injury severity. CONCLUSIONS: IPPS is a relatively simple and objective tool that uses data available in trauma center registries to rank injury causes according to both frequency and severity. Differences between two centers and across age groups suggest IPPS may be useful in tailoring injury prevention programs to local population needs.

Adolescent↗

PubMed2005

The evolution of trauma care at a level I trauma center.

BACKGROUND: My colleagues and I compared trauma patient demographics and outcomes between two time periods in the last 10 years in our Level I trauma center to evaluate the impact of the marked evolution in trauma care and determine additional opportunities for improvement. METHODS: Our trauma registry was queried for adult trauma patients admitted from 1991 to 1993 (EARLY) and 1999 to 2001 (LATE). The EARLY period predated creation and maturation of a dedicated trauma service and Level I trauma center verification. Continuous data were compared using Student's t-test, and categorical data using chi-square. RESULTS: Increased transfers of severely injured patients from regional hospitals, combined with fewer admissions for "observation," resulted in fewer, but sicker, patients admitted in the LATE period. Patients were considerably older in the LATE period and mortality was higher. Despite higher acuity of patients, hospital and ICU lengths of stay were shorter in the LATE period. Nonoperative management of solid organ injuries was more common in the LATE period, but the overall operative volume was similar. Nonsurvivors in the LATE period had higher Injury Severity Scores and were older compared with the EARLY period. Mortality attributable to blunt CNS injury was higher, and that attributed to late sepsis and multiple organ failure was lower in the LATE period. CONCLUSIONS: Over the past decade, more older, severely injured patients have been admitted to our Level I trauma center. Overall mortality among these higher acuity patients has increased, with a marked shift in attributable mortality to CNS injury and away from late sepsis and multiple organ failure. This highlights the need for continued efforts to identify optimal management strategies for severe brain injury. Additional areas for improvement include enhancement of our regional trauma network and injury prevention initiatives.

Adult↗

PubMed1995

Trauma centers in the United States: identification and examination of key characteristics.

OBJECTIVES: To identify all hospitals in the United States that operated a trauma center between 1980 and 1991 and to contrast their organizational, service, and medical staff characteristics. DESIGN: Trauma centers were identified through a series of surveys and follow-up discussions with state emergency medical service directors. Data on hospital characteristics were obtained through the American Hospital Association's 1990 Annual Survey of Hospitals. MATERIALS AND METHODS: Hospital characteristics were compared across: (1) hospitals with and without trauma centers; (2) operational and closed trauma centers; and (3) trauma centers-based on trauma level and source of designation. MEASUREMENTS AND MAIN RESULTS: Overall, 471 operational trauma centers and 58 hospitals that dropped this service were identified. Several differences were found in hospital operational, service, and medical staff characteristics across hospitals with and without trauma centers and across trauma centers distinguished by trauma level and by whether they continued to provide the service through 1991. Few differences were present across formally designated and self-designated centers. CONCLUSIONS: The study provides structural and organizational profiles of trauma centers that should help trauma system planners identify strong candidates for trauma center designation.

Data Collection↗

PubMed2005

The academic trauma center is a model for the future trauma and acute care surgeon.

BACKGROUND: Strategies to prevent the extinction of the trauma surgeon have focused on increasing the operative potential by including nontrauma general surgery emergencies. Although providing comprehensive emergent surgical care by the trauma service may seem novel, our institution has embraced this concept for the past 25 years. Recent discussions on the future of trauma surgery stimulated us to review our experience as a possible model for the future trauma and acute care surgeon. METHODS: We reviewed operative logs for 2002 and 2003 at our urban academic Level I trauma center. Six surgeons participate equally in call that covers trauma and nontrauma general surgical, thoracic, and vascular emergencies. Cases were classified as trauma, emergent, urgent, or according to the patient's clinical condition. The primary procedure for each operation was classified according to the American Board of Surgery Case Reporting System. RESULTS: We performed 4,082 operations during the study period, of which 8% were trauma, 11% were emergent, 40% were urgent, and 41% were elective. Abdominal and alimentary procedures accounted for 53% of all operations. Vascular, thoracic, and head and neck procedures accounted for 22%, 14%, and 9% of procedures, respectively. CONCLUSION: To resurrect our discipline, we must reclaim and expand our operative potential and be relieved of our excessive night and weekend burden of serving as housestaff for the neurosurgeons, orthopedic surgeons, and interventional radiologists. The trauma surgeon can effectively manage trauma and acute care surgery emergencies including thoracic and vascular conditions. Education of the future trauma and acute care surgeon must include specialty training in thoracic and vascular surgery.

Academic Medical Centers↗

PubMed1996

Response after out-of-hospital cardiac arrest in the trauma patient should determine aeromedical transport to a trauma center.

OBJECTIVE: To evaluate whether aeromedical transport of trauma patients who sustain an out-of-hospital cardiac arrest (OHCA) is justified. DESIGN: Retrospective chart review. METHODS: We reviewed the outcome of 67 consecutive patients after OHCA with initial resuscitation who were transported to a Level I trauma center. Statistical analysis was used to develop a predictive model for survival. RESULTS: The overall survival was 19%. One of 28 patients with a second OHCA survived (p = 0.005). Logistic regression analysis demonstrated that the Revised Trauma Score at trauma center arrival (1.0 +/- 0.25, nonsurvivors vs. 5.15 +/- 0.86, survivors, p = 0.0001), Injury Severity Score (34.9 +/- 2.9, nonsurvivors vs. 21.3 +/- 4.1, p = 0.037) and a sinus-based cardiac rhythm at the time of aeromedical team arrival were predictive of survival (R2 = 0.57, p = 0.0001). Survivors were more likely to have been transported from an outside hospital (28% vs. 8% for scene runs), had a sinus rhythm on team arrival (42% vs. 3%), and maintained a sinus rhythm on arrival at the trauma center (41% vs. 0%); however, these parameters were not predictive of survival in the statistical model. The neurologic outcome of the 13 survivors was good (preinjury state) in three cases, moderate disability (independent living) in three, severe disability (needing assistance) in five, and persistent vegetative state in two. Regression analysis was unable to differentiate survivors with a good neurologic recovery from the rest of the patient population. CONCLUSIONS: These results suggest that: (1) trauma patients who are resuscitated to a sinus rhythm after OHCA should be transported to a trauma center; (2) Revised Trauma Score and Injury Severity Score are useful to predict survival; and (3) neurologic outcome is not accurately predicted by this model.

Air Ambulances↗

PubMed2005

Effect of the Uniform Accident and Sickness Policy Provision Law on alcohol screening and intervention in trauma centers.

BACKGROUND: Alcohol screening and intervention in trauma centers are widely recommended. The Uniform Accident and Sickness Policy Provision Law (UPPL) exists in most states, and allows insurers to refuse payment for treatment of injuries in patients with a positive alcohol or drug test. This article analyzed the UPPL's impact on screening and reimbursement, measured the knowledge of legislators about substance use problems in trauma centers, and determined their opinions about substance use-related exclusions in insurance contracts for trauma care. METHODS: A nationwide survey of members of the American Association for the Surgery of Trauma was conducted. A separate survey of legislators who are members of the Senate, House, or Assembly and serve in some leadership role on committees responsible for insurance in their state was also performed. RESULTS: Ninety-eight trauma surgeon and 56 legislator questionnaires were analyzed. Surgeons' familiarity with the UPPL was limited; only 13% believed they practiced in a UPPL state, but 70% actually did. Despite lack of knowledge of the statute, 24% reported an alcohol- or drug-related insurance denial in the past 6 months. This appeared to affect screening practices; the majority of surgeons (51.5%) do not routinely measure blood alcohol concentration, even though over 91% believe blood alcohol concentration testing is important. Most (82%) indicated that if there were no insurance barriers, they would be willing to establish a brief alcohol intervention program in their center. Legislators were aware of the impact of substance use on trauma centers. They overwhelmingly agreed (89%) that alcohol problems are treatable, and 80% believed it is a good idea to offer counseling in trauma centers. As with surgeons, the majority (53%) were not sure whether the UPPL existed in their state, but they favored prohibiting alcohol-related exclusions by a 2:1 ratio, with strong bipartisan support. CONCLUSIONS: The study documents strong support for screening and intervention programs by both trauma surgeons and legislators. Surgeons experience alcohol-related insurance denials but are not familiar with the state law that sanctions this practice. A majority of legislators are also not familiar with the UPPL but support elimination of insurance statutes that allow exclusion of coverage for trauma care on the basis of intoxication.

Alcoholic Intoxication↗

PubMed2003

Is there a relationship between trauma center volume and mortality?

BACKGROUND: The guidelines for Level I trauma center verification require 1,200 admissions per year. Several studies looking at the relationship between hospital volume and outcomes after injury have reached conflicting conclusions. The goal of our study was to examine the relationship between patient volume and outcomes (mortality and length of hospital stay) in California's trauma centers. METHODS: Data for patients >or= 18 years old admitted after injury (n = 98,245) to a Level I or II trauma center (n = 38) in 1998 and 1999 were obtained from the Patient Discharge Data of the State of California. Hospital volume was derived from the annual number of admissions per center, and covariates including age, sex, mechanism of injury, Injury Severity Score, and trauma center designation were analyzed. RESULTS: Hospital volume was not a significant predictor of death or length of hospital stay. More severely injured patients appeared to have worse outcomes at the highest volume centers. CONCLUSION: In our study, hospital volume was not a good proxy for outcome. Low-volume centers appeared to have outcomes that were comparable to centers with higher volumes. Perhaps institutional outcomes rather than volumes should be used as a criterion for trauma center verification.

Analysis of Variance↗

PubMedDate not supplied

Delay in ED arrival resulting from a remote helipad at a trauma center.

INTRODUCTION: Ground transport from a remote helipad at a trauma center may delay patient arrival in the ED and affect patient morbidity and mortality. Prehospital care providers must be aware of the magnitude of any delay when selecting the most expedient means of transport for trauma patients. This study quantifies the time required for a 0.6-mile ground transport from a remote trauma center helipad to an ED through two traffic signals along one city street. METHODS: The trauma registry was queried for all patients transported directly from the scene to the regional trauma center by helicopter between January 1993 and October 1996. Prehospital records were used to supplement missing time data; patients with incomplete data were excluded. Ground transport time was calculated by subtracting the time that the helicopter arrived at the remote helipad from the time the ambulance arrived at the ED. Mean ground transport time and standard deviation were calculated. RESULTS: Three-hundred-eighty-nine trauma patients were transported directly from the scene to the regional trauma center by helicopter. Complete data were available for 345 patients (89%). Mean ground transport time was 5.2 +/- 2.3 minutes. CONCLUSION: The need for ground ambulance transport from this remotely located trauma center helipad adds more than 5 minutes to total prehospital time. This delay in ED arrival may be significant for some patients and should be taken into account when selecting the most appropriate mechanism of patient transport and planning helipad construction.

Air Ambulances↗

PubMed2002

The Outreach Trauma Program: a model for survival of the academic trauma center.

BACKGROUND: In the current health care climate, trauma centers face particular economic challenges. Statewide trauma systems provide a network for referral of critically injured patients to academic Level I trauma centers, but favorable reimbursement in states such as Colorado results in intense competition for patients. We hypothesized that a comprehensive Outreach Trauma Program would facilitate our mission as a key resource facility in our trauma system, and would increase referrals of critically injured patients to our center from outside our metropolitan area. METHODS: The Colorado statewide trauma system was formalized in 1995; our Outreach program-including providing visiting trauma call, continuing medical education lectures, 24-hour/7-day immediate consultation and transfers, and public relations/marketing-was fully implemented in 1997. We audited our trauma registry from January 1994 to July 2001 to determine the impact on patient volume and acuity as well as academic productivity. RESULTS: Annual overall trauma admissions have remained stable. Since 1997, high-acuity patients (i.e., Injury Severity Score > 15, intensive care unit admissions, those requiring surgery) have increased 27% to 51%, attributable largely to an approximately 300% increase in high-acuity Outreach patients. In 2000, Outreach patients constituted 8% of our total trauma admissions, but 21% of intensive care unit trauma admissions; notably, they accounted for 25% of our center's trauma charges. Meanwhile, our group's academic productivity has not suffered; in fact, we had 57 publications in 2000, compared with an average of 35 per year from 1993 through 1997. CONCLUSION: The Outreach Trauma Program has proven clinically, academically, and financially rewarding. Our program may serve as a model whereby academic trauma centers, through a demonstrated commitment to serving the clinical and educational needs of their referral base, can satisfy their mission while ensuring their survival.

Academic Medical Centers↗

PubMed1988

Trauma mortality and trauma center designation: an international comparison.

In order to compare trauma mortality of a designated Level I Trauma Center in the United States with a major metropolitan hospital in New Zealand, patients presenting to these institutions were reviewed. Over a 1 year period 824 patients (62 deaths) presented to the Southern New Jersey Regional Trauma Center (SNJRTC) and 602 (60 deaths) to the Resuscitation room at Auckland Hospital (AH). There were no differences between age or severity of injury in those patients dying at the two institutions but brain injury was significantly more common a cause of death at Auckland Hospital (P less than 0.001). At SNJRTC exsanguination was significantly more common (P less than 0.05) and patients were more likely to die in the admitting area (P less than 0.01). The results confirm the similarity of the trauma mortality between a major metropolitan hospital in New Zealand and a United States Level I Trauma Center dealing primarily with blunt trauma. Effectiveness of trauma care in the two locations as judged by the average Injury Severity Score of CNS and non-CNS related deaths, is comparable. This suggests that despite not being completely equipped as a Level I Trauma Center the commitment to caring for patients at the New Zealand hospital is an important factor affecting the outcome.

Adult↗

PubMed1996

Representativeness of trauma center registries for farm injury surveillance.

Trauma center registries are the foundation for many surveillance systems that attempt to define the frequency and spectrum of various types of injuries. To assess the representativeness of trauma center-based farm injury surveillance, we evaluated data for 1986-1991 from the Marshfield Clinic/St Joseph's Hospital, a major trauma center located in Central Wisconsin. We compared the pattern of farm injuries seen in residents of the Marshfield Epidemiologic Surveillance Area (MESA), a geographically defined, population-based surveillance area, with those from outside MESA, a nonpopulation-based mix of primary care and referral patients typical of most trauma registries. The population-based and nonpopulation-based surveillance data suggested similar patterns with respect to seasonality, circumstances of injury, and source of injury. There were significant differences with respect to the body part injured, severity of injury, and selected aspects of acute medical care. While useful for many purposes, trauma center-based injury surveillance data should be interpreted cautiously.

Accidents, Occupational↗

PubMed1997

Function of "nontrauma" surgeons in level I trauma centers in the United States.

Although the general "trauma" surgeon is usually the team leader in level I trauma centers, the use of surgical subspecialists and nonsurgeons is frequently ill-defined. This study was done to gain data in regard to actual use of subspecialists in busy centers. First, a survey of the patterns of staffing in 140 trauma centers was elicited by mail questionnaire, supplemented by telephone cells. Second, records of 400 consecutive patients at the Elvis Presley Trauma Center were reviewed to determine the use of subspecialists during the first 24 hours of care of individual patients. There were differences in the use of surgical subspecialists and nonsurgeons at different centers: in receiving, admitting, operating, and critical care areas and in privileges for admission and attending of inpatients. Consultation "guidelines" are used for many specific injuries. At our center, a mean of 1.92 subspecialists, in addition to general surgeons, were involved in the early care of each patient. Problems exist in many centers regarding the use of subspecialists, especially for management of facial and chest injuries. In some centers nonsurgeons function in the intensive care unit, and as admitting and attending physicians of trauma patients.

Data Collection↗

PubMed2004

Variability in trauma center outcomes for patients with moderate intracranial injury.

BACKGROUND: The variability of outcome between Trauma Centers has not been extensively studied as a possible avenue for performance improvement. Trauma Center variability in severity-adjusted survival for patients with moderate intracranial injury (MII) was studied in order to determine the association of MII-related process of care variables with outcomes. The analytic results were supplemented with peer review of MII patients with unexpected outcomes and identified potential process of care variables. METHODS: A retrospective cohort study was undertaken based on data submitted to a statewide trauma center database from July '95 through June '98. MII patients had one or more selected ICD-9-CM codes with an AIS-90 severity score of 3 or 4 but no higher. Severity adjustment was done using case matching and a logistic function based New Model that appropriately accounts for patients intubated on Emergency Department arrival. MII-related process of care variables derived from the database were identified and their relationship with outcome were evaluated individually and using multivariate methods. Trauma center personnel conducted standardized peer reviews. RESULTS: The study included data from 6765 patients treated at 26 trauma centers. Two centers (2PZW) had significantly more survivors than expected by both severity adjustment methods. Three had significantly fewer survivors than expected (3NZW). By several measures, patients treated in the 2PZW centers were more seriously injured and older than those in the 3NZW centers. CT of the head performed in the treating hospital was the only process of care variable associated with outcome in multivariate evaluations. Peer review also found little association between process of care variables and patient outcomes. However, peer review reported that 23.7% of unexpected deaths identified by case matching or the New Model were preventable or potentially preventable. Peer review also identified as medically unnecessary significant percentages of patients with unexpectedly long stays in hospital (26.4%) or in ICU (17.3%) identified by case matching. Nearly 45% of unexpected complications were judged preventable or potentially preventable. CONCLUSIONS: Two severity adjustment methods identified significant variability in trauma center outcomes for patients with MII. The difference in outcomes between the centers with better than expected (2PZW) and poorer than expected outcomes (3NZW) was substantial. Peer review identified significant opportunities for reducing unexpected deaths, stays in hospital and in ICU, and the occurrence of complications. Trauma registry data and peer reviews found little relationship between available process of care variables and patient outcomes. This study should stimulate discussions to understand reasons for outcome variability and ways to reduce it.

Adult↗

PubMed2001

The use of telemedicine for real-time video consultation between trauma center and community hospital in a rural setting improves early trauma care: preliminary results.

BACKGROUND: By geographic necessity, rural trauma patients must be initially stabilized at local community hospitals before transfer for definitive care. In this study, it was hypothesized that telemedicine consults with trauma surgeons from a Level I trauma center online while the patient was still in the community hospital ED could positively affect care. METHODS: Four community hospital emergency departments in upstate New York and Vermont were equipped with dual cameras with remote control capability. Three trauma surgeons' homes were wired and equipped with telemedicine systems. Protocols were developed for the initiation of a telemedicine consult. RESULTS: There were 26 telemedicine consults over an 8-month period. The telemedicine population was significantly more severely injured and had a higher mortality than the general trauma population admitted to the Level I trauma center. In two cases, it was felt that the telemedicine consultation was potentially lifesaving. On follow-up, more than 80% of the referring providers felt that the telemedicine consult improved care. CONCLUSION: Telemedicine provides a virtual online trauma surgeon to assist with the resuscitation and stabilization of the major trauma patient in a small community hospital. These preliminary results show a positive impact on rural trauma patient care at the local community hospital.

Adolescent↗

PubMed1996

The outcome for children with blunt trauma is best at a pediatric trauma center.

PURPOSE: The mortality rate for pediatric trauma patients cared for in adult trauma centers has been shown, by means of TRISS methodology, not to differ significantly from that of the Major Trauma Outcome Study (MTOS). The question remains, however, whether the outcome of injured children is better in a designated pediatric trauma center (DPTC). The authors' hypothesis is that outcome is better at a DPTC. METHODS: The records of 1,797 children (0 to 15 years of age) admitted to a DPTC between 1987 and 1993 were reviewed. TRISS methodology was used to calculate probability of survival for outcome comparison with the MTOS. The data also was compared with outcome in relation to the admitting Glasgow Coma Score (GCS) reported in the National Pediatric Trauma Registry (NPTR). RESULTS: The outcome of all children at this DPTC had a Z score of +1.4199 (P > .1). The Z score of children admitted because of penetrating trauma (PT, n = 460) did not differ significantly from that of the MTOS. However, the children admitted because of blunt trauma (BT, n = 1,337) had a Z score of +3.3501 (M score = .90), which is significantly better than that of the MTOS (P < .001). The BT population with an ISS of > or = 9 (n = 149) had a Z score of +2.8686 (P < .005) (M = .95). By GCS comparison, the BT group had a outcome similar to that reported in the NPTR. Head injury was the cause of death for 26 (84%) of the 31 PT deaths and 20 (83%) of the 24 BT deaths (three of the remaining four had associated severe head injury). Only 1 of 24 (4%) BT liver injuries and 5 (21%) of 24 BT splenic injuries required surgical intervention. This low incidence of liver and splenic surgical invention is similar to that reported by other DPTCs, but for children treated at adult centers the rates are 37% to 58% and 43% to 53% for liver & splenic surgical intervention, respectively. CONCLUSION: Children with BT have a significantly better outcome at a DPTC; the outcome for children with PT does not differ. Successful nonoperative treatment of blunt abdominal injuries is more likely to occur at a DPTC than at adult trauma centers "with pediatric committment." Thus, children with blunt injuries should be taken to a DPTC, when available.

Adolescent↗

PubMed2006

Pediatric trauma deaths: a three-part analysis from a nonacademic trauma center.

A three-part analysis was undertaken to assess pediatric trauma mortality in a nonacademic Level II trauma center at Parkview Hospital in Fort Wayne, Indiana. Part I was a comparison of Parkview trauma registry data collected from 1999 through 2003 with those of pediatric and adult trauma centers in Pennsylvania. The same methodology used in Pennsylvania was used for the initial evaluation of pediatric deaths from trauma in our trauma center. Part II was a formal in-depth analysis of all individual pediatric deaths as well as surgical cases with head, spleen, and liver injuries from the same time frame. Part III proposes a new methodology to calculate a risk-adjusted mortality rate based on the TRISS model for the evaluation of a trauma system. The use of specific mortality and surgical intervention rates was not an accurate reflection of trauma center outcome. The proposed risk-adjusted mortality rate calculation is perhaps an effective outcome measure to assess patient care in a trauma system.

Adolescent↗