SEARCH · PubMed Health

Results for “Trauma Centers”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed2001

A statewide analysis of level I and II trauma centers for patients with major injuries.

BACKGROUND: This study examines statewide outcomes and resource use in Level I and II trauma centers for patients with major injuries. METHODS: This study analyzed trauma registry data on patients admitted to North Carolina Level I and II trauma centers from January 1995 to December 1996 with one of four major injuries: thoracic aortic disruption, liver injury, pelvic fracture, or pulmonary contusion. RESULTS: There were 59 thoracic aortic disruptions, 109 liver injuries, 153 pelvic fractures, and 962 pulmonary contusions identified among 26,030 admissions. Case fatality was not significantly different (Level I, 16.8%; Level II, 14.9%). Hospital charges were significantly higher in Level I centers (Level I, $47,366; Level II, $35,490), but this difference was confined to transferred patients. Controlling for Revised Trauma Score, Injury Severity Score, age, gender, and race, multivariable regression confirmed findings regarding hospital charges, and multiple logistic regression confirmed findings regarding case fatality. CONCLUSION: Case fatality was similar in Level I and Level II trauma centers in North Carolina, and hospital charges were comparable in patients with comparable injuries not requiring transfer. This suggests that patients with major injuries may be optimally cared for in both Level I and Level II trauma centers.

Adolescent↗

PubMedDate not supplied

Analgesic prescription and administration to adolescents admitted to an adult versus pediatric trauma center.

OBJECTIVE: To compare the prescription and administration practices for narcotic and non-narcotic analgesics given to injured adolescents admitted to an adult versus pediatric trauma center. METHODS: A retrospective chart review of 45 medical records for documentation of prescribed and administered analgesics in the first 48 hours of hospitalization. RESULTS: Adolescents treated at the adult trauma center had significantly more narcotics ordered in the first 24 hours of admission compared to adolescents in the pediatric trauma center. However, when controlling for injury severity, there was no difference between the narcotic administration at the two trauma centers. There were no differences in the types or numbers of doses of non-narcotic analgesics prescribed or administered. CONCLUSION: There were no differences in the prescription or administration of narcotic and non-narcotic analgesics to injured adolescents in an adult versus a pediatric trauma center. Future research should focus on the prospective enrollment of injured adolescents at additional trauma centers and a larger sample size to validate or refute these findings.

Adolescent↗

PubMed2003

The integral role of the plastic surgeon at a level I trauma center.

The role of plastic surgery in urban level I trauma centers in the United States has been largely undefined, despite the undeniable historical involvement of plastic surgery in reconstruction of posttraumatic defects. To explore and define this role, case data were prospectively collected during a 29-month period following initiation of a full-time plastic surgery position at an established urban level I trauma center. Referring and/or interacting surgical service, anatomical area of interest, and procedure data were tabulated. A total of 1009 operative reports comprising 1104 procedures were recorded. The most common interacting surgical services were orthopedics and general/trauma surgery; however, interaction occurred with a total of 10 surgical specialties. The upper extremity was the most common anatomical area operated on followed by head and neck, lower extremity, trunk, urogenital, and breast. A wide variety of procedures were performed in each anatomical area, demonstrating the broad scope of reconstructive surgery practiced in a trauma setting. Three hundred and twenty-four procedures involved expertise in microsurgery, flaps, and burn or frostbite care. Additional procedures commonly performed demonstrated considerable overlap with other fields of surgical specialization. This overlap in skills proved advantageous in distribution of facial trauma call and hand surgery coverage. Data presented in this study reinforce the idea that plastic surgery is a specialty defined by concept rather than anatomical area, and also demonstrate a significant role for plastic surgeons in a level I trauma center.

Colorado↗

PubMed1994

Identification and categorization of and cost for care of trauma patients: a study of 12 trauma centers and 43,219 statewide patients.

Medical and demographic data for trauma patients (n = 7120) admitted to 12 trauma centers in 1 year were reviewed. Data from New York State on all discharges for the same year (n = 2,535,501) were obtained and analyzed. Patients were identified as trauma patients based on NYC EMS trauma center advisory committee criteria translated into ICD-9-CM codes, and a computer-based algorithm was developed that identified 43,219 trauma patients. A standard resource cost (SRC) was also developed to compare relative cost among trauma and non-trauma patients in the same diagnosis-related groups (DRGs). The mean age of the 43,219 trauma patients was 43.1 years, 61.8% were male, the mean LOS was 13.4 days, the mean ISS was 10.4, and 61% were discharged from community hospitals. Trauma centers treated the more severely injured patients: mean ISSs were 12.3, 10.9, and 9.2 for level I, level II, and community hospitals, respectively. Payor mix varied by category, with 71% of penetrating trauma victims covered by Medicaid or self pay compared with 21% of blunt trauma victims. Level I centers treated twice as many self-pay and Medicaid patients as community hospitals. A comparison of relative cost showed that trauma patients cost 27.5 million dollars more than non-trauma patients in the same DRGs.

Adult↗

PubMed2002

The profile of level I trauma center directors.

BACKGROUND: No data are available regarding the characteristics of the trauma directors of Level I trauma centers. METHODS: Questionnaires were mailed to 102 directors of Level I trauma centers. Data were analyzed in a blinded fashion. RESULTS: Seventy-two directors responded. All were men, with a mean age of 48 +/- 6 years. Fifty-eight percent of directors were fellowship trained. Directorship was assumed 7.3 +/- 6.1 years after training and the average time on the job was 8.6 +/- 6.1 years. Directors work in urban (93%), university-affiliated (67%) institutions that admit 1,000 to 2,000 patients annually (50%). Practice time distribution is as follows: trauma clinical care, 33%; general surgery, 20%; administrative work, 18%; critical care delivery, 17%; and research, 11%. Directors take 6.6 +/- 2.2 night calls per month, with half of them taking in-house call. Eighty-eight percent of directors are involved in research. Seventy-eight percent of directors earn $200,000 to $325,000 per year, with the largest group making $225,000 to $250,000. Salary is derived from clinical revenues (42%) and hospital (37%) or university (20%) support. Compensation is higher in community hospitals and tends to be higher in the Midwest. CONCLUSION: The profile of the trauma director at a Level I trauma center was described. This may be important in trauma career and systems development.

Adult↗

PubMed1987

Physician-staffed helicopter scene response from a rural trauma center.

One hundred ten consecutive trauma patients transported directly from the scene of injury by a hospital-based helicopter emergency medical service were reviewed. These patients were injured in the rural areas of central and northeastern Pennsylvania and were transported to a level I trauma center. The medical flight team consisted of an emergency physician and a registered nurse. The average round-trip flight distance was 44 miles. The overall mortality was 21.8%. Eighty-eight percent of the injuries were motor vehicle related. Only two patients received advanced life support prior to arrival of the helicopter. Forty-five percent of patients required major intervention by the medical flight team at the scene. The average scene time was 33.6 minutes for transported patients. Sixteen patients required extrication after the arrival of the flight crew and had significantly prolonged scene times averaging 61.8 minutes (P less than .001). Patient entrapment was the most important contributing factor in on-scene ground time.

Aircraft↗

PubMed1995

Trauma centers in a managed care environment.

Health care reform will affect the relationship of trauma centers to health maintenance organizations and other managed care plans. We studied Kaiser Permanente Medical Center (Kaiser) members admitted to the Trauma Center at San Francisco General Hospital (SFGH) to determine: (1) variables predicting transfer from SFGH to a Kaiser Hospital (repatriation), (2) the length of hospital stay (LOS), and (3) the cost of their care. The SFGH trauma registry provided data on 7,794 patients admitted before 1994. To investigate LOS, 89 Kaiser patients over 1 year were matched with non-Kaiser patients on age, maximum Abbreviated Injury Scale score (MAIS) by body region, Injury Severity Score (ISS), head injury severity, and blunt or penetrating injury and disposition. Kaiser patients were significantly younger, more likely to have blunt injury, and had a lower death rate. Significant predictors of repatriation were an MAIS score > or = 3, abdominal or extremity injury, and an ISS score of 26 to 40. The mean LOS for all Kaiser patients was 7.6 days, compared with 4.8 for controls (p = 0.20). However, mean LOS was significantly longer in repatriated Kaiser patients compared with controls (16 vs. 7.8 days, p < 0.0005). Kaiser reimbursement rates were comparable with commercial payors, but higher than others. A relatively small number of severely injured patients account for a large percentage of costly trauma care. Analyses of patient subsets are necessary for trauma centers to negotiate suitable relationships with managed care plans. A prospective study is needed to examine the cost efficiency of early transfer of managed care patients.

Adult↗

PubMed2000

Utilization of FAST (Focused Assessment with Sonography for Trauma) in 1999: results of a survey of North American trauma centers.

Although much has been written about FAST (Focused Assessment with Sonography for Trauma) in the last decade little is known about its present clinical utilization. The purpose of this study was to evaluate and characterize the contemporary utilization of FAST at trauma centers in the United States and Canada. In 1999 trauma directors or their delegates at Level I regional trauma centers in the United States and Canada were surveyed either by fax or phone regarding the present utilization and the future of FAST at their center. The overall survey response rate was 91 per cent with 96 of 105 centers completing the survey. Of the 96 centers surveyed 78 were in the United States and 18 were in Canada. Of the 78 U.S. centers surveyed 62 (79%) routinely use FAST, and it is done by surgeons in 39 per cent, surgeons and emergency departments in 21 per cent, emergency departments in 5 per cent, and radiologists in 35 per cent. Most centers (79%) thought that it sped up their workups, and 89 per cent said it was an advance in patient care. FAST is used in penetrating injury at 58 per cent of centers, and some centers use FAST to assess organ injury. The utilization of diagnostic peritoneal lavage and CT has markedly decreased at many centers. Almost all respondents thought that FAST should be a component of surgery resident training. The utilization of FAST is significantly less in Canada than in the United States (P < 0.05). Our conclusions are the following. FAST has become routinely used at the majority of the U.S. centers surveyed. FAST is performed by clinicians at 65 per cent of the trauma centers surveyed. The utilization of CT and diagnostic peritoneal lavage has changed. Many centers have broadened the scope of FAST to include the assessment of organ, pediatric, and penetrating injury.

Abdominal Injuries↗

PubMed1995

The role and significance of research in a specialized trauma center.

Compared with nonspecialized hospitals, specialized trauma centers on university or research institute campuses are distinguished by lower mortality, morbidity, and mean hospital stay because of the permanent influence research has on the results of clinical practice. Close collaboration between researchers and clinicians in St Petersburgh Trauma Shock Center helped to develop medical knowledge and technology in the initial prognostic evaluation of the injured patient in shock, to improve surgical protocols in relation to prognosis, and to develop treatment for endotoxemia and sepsis.

Diffusion of Innovation↗

PubMed1989

Head injury at the southeastern Georgia Regional Trauma Center: a three-year review.

The impact of head injury on our trauma center is significant because of the large number of cases with their heavy utilization of trauma center resources. Head injury also exerts a major influence on the Trauma Center in a rural area since it serves as a major provider of care for the head injured over a wide geographical area. Mortality rates seen in this population compare favorably with contemporary data from other studies using GCS and Head AIS as indicators of level of injury.

Craniocerebral Trauma↗

PubMed2006

Communication technology in trauma centers: a national survey.

The relationship between information and communication technology (ICT) and trauma work coordination has long been recognized. The purpose of the study was to investigate the type and frequency of use of various ICTs to activate and organize trauma teams in level I/II trauma centers. In a cross-sectional survey, questionnaires were mailed to trauma directors and clinicians in 457 trauma centers in the United States. Responses were received from 254 directors and 767 clinicians. Communication with pre-hospital care providers was conducted predominantly via shortwave radio (67.3%). The primary communication methods used to reach trauma surgeons were manual (56.7%) and computerized group page (36.6%). Computerized group page (53.7%) and regular telephone (49.8%) were cited as the most advantageous devices; e-mail (52.3%) and dry erase whiteboard (52.1%) were selected as the least advantageous. Attending surgeons preferred less overhead paging and more cellular phone communication than did emergency medicine physicians and nurses. Cellular phones have become an important part of hospital-field communication. In high-volume trauma centers, there is a need for more accurate methods of communicating with field personnel and among hospital care providers.

Analysis of Variance↗

PubMed1995

Institution and per-surgeon volume versus survival outcome in Pennsylvania's trauma centers.

BACKGROUND: The American College of Surgeons recommends minimum patient volumes for trauma centers and surgeons. Those numbers, however, are largely based on results from studies of surgical (but not trauma) relationships between volume and outcome. METHODS: Using stepwise regression, relationships were sought between measures of patient volume per trauma center and per surgeon and ana severity-controlled measure of survival outcome (W). For significant z values, W is the number of additional (or fewer) survivors, per 100 patients treated, than expected from ASCOT norms. W = 0 when z is nonsignificant. Data are from patients admitted in 1988 and 1989 to accredited Pennsylvania trauma centers. RESULTS: The relationships found for all patients and for adult blunt-injured patients are W = 0.3312 + 0.0200 (NSER/SURG) and W = 0.3638 + 0.0248 (NBSER/SURG), respectively, where NSER/SURG is the number of seriously, injured patients treated annually per surgeon and NBSER/SURG is the number of adult patients with serious blunt injuries treated annually per surgeon. Serious injury was defined, using the Injury Severity Scale, as > = 13 or, using the Abbreviated Injury Scale, as a head injury of > = 3. The relationships explained 36% and 61% of the variance in W (R2 for all patients and adult blunt-injured patients, respectively. To achieve normative survival (W =0), 95% confidence intervals suggest that a trauma surgeon should treat at least 35 seriously injured patients per year and at least 28 adult patients with serious blunt injury annually. No volume-related variable was a significant contributor to predictions of W for adult patients with penetrating injuries or for pediatric patients. CONCLUSIONS: These results support the regionalization of trauma care by affirming that increased per-surgeon experience in the treatment of seriously injured patients is associated with improved outcomes and help define the minimum experience needed to achieve normative survival. Prospective study of the relationship between volume and survival and other outcomes is required.

Adult↗

PubMed1994

Outcomes following injury in a predominantly rural-population-based trauma center.

OBJECTIVE: To determine the incidence, severity, and outcomes of injury in patients treated in a rural-based level I trauma center and to compare the outcomes with a nationally indexed patient population--the Major Trauma Outcome Study. DESIGN: Retrospective evaluation of trauma registry data. SETTING: State of Illinois designated level I trauma center located in Urbana. PATIENTS: A total of 2246 trauma patients admitted from August 1989 through August 1992, with a mortality cohort of 158 patients. There were 1735 patients (77%) with Injury Severity Scores less than or equal to 19 and 511 patients (23%) with more severe injuries (Injury Severity Scores > or = 20). MAIN OUTCOME MEASURES: Mortality rates using the TRISS method, the Major Trauma Outcome Study, and final patient dispositions. RESULTS: The overall mortality rate, excluding those patients who were pronounced dead on arrival, was 125/2213 (5.6%). Eighty-six (69%) of these 125 patients had neurological Abbreviated Injury Scores of 3 or greater, with neurotrauma being a major contributor to their deaths. The m-statistic was 0.99 and the z-statistic was -3.30 for the entire group. The observed probability of survival met or exceeded the expected probability of survival when compared with the Major Trauma Outcome Study in all categories. CONCLUSION: Acceptable mortality rates compared with the Major Trauma Outcome Study can be achieved in a rural-community-based level I trauma center despite relatively small numbers of critically injured patients. Such outcomes may assist in justifying resource allocation for trauma centers in rural areas.

Abbreviated Injury Scale↗

PubMed2005

Is outcome after blunt splenic injury in adults better in high-volume trauma centers?

An association between outcome and case volume has been demonstrated for selected complex operations. The relationship between trauma center volume and patient outcome has also been examined, but no clear consensus has been established. The American College of Surgeons (ACS) has published recommendations on optimal trauma center volume for level 1 designation. We examined whether this volume criteria was associated with outcome differences for the treatment of adult blunt splenic injuries. Using a state trauma database, ACS criteria were used to stratify trauma centers into high-volume centers (>240 patients with Injury Severity Score >15 per year) or low-volume centers, and outcome was evaluated. There were 1,829 patients treated at high-volume centers and 1,040 patients treated at low-volume centers. There was no difference in age, gender, emergency department pulse, emergency department systolic blood pressure, or overall mortality between high- and low-volume centers. Patients at low-volume centers were more likely to be treated operatively, but the overall success rate of nonoperative management between high- and low-volume centers was similar. These data suggest that ACS criteria for trauma centers level designation are not associated with differences in outcome in the treatment of adult blunt splenic injuries in this regional trauma system.

Adult↗

PubMed1995

Stabilization of rural multiple-trauma patients at level III emergency departments before transfer to a level I regional trauma center.

STUDY OBJECTIVE: To determine whether triage and stabilization of severely injured rural trauma victims in outlying Level III emergency departments before transfer to Level I trauma centers results in outcomes similar to national normative data. DESIGN: Retrospective review of trauma transfers and deaths during a 4-year period. SETTING: Two Level III EDs in rural, upstate New York and an urban Level I regional trauma center. PARTICIPANTS: Fifty multiple-trauma victims with a Trauma Triage Score (T-RTS) of < or = 11 or less. Forty-three patients were stabilized before transfer, and 7 died in the rural Level III ED. RESULTS: There were 45 blunt injuries and 5 penetrating injuries. Mean patient age was 34 years (range, 9 months to 97 years). The Revised Trauma Score (RTS) on admission to the Level III ED was calculated for each patient (median score, 5.97; interquartile range (IQR), 4.09 to 6.90), as was the ultimate Injury Severity Score (ISS) (median score, 23; IQR, 13 to 29). With TRISS methodology, probabilities of survival (Ps) and death (Pd) were calculated. Results were compared with the Major Trauma Outcome Study (MTOS) by use of current coefficients derived from Walker-Duncan regression analysis of MTOS data. The predicted number of deaths was 13.5, whereas the actual number was 12, Z statistic, -.710. There were two unexpected survivors and three unexpected deaths. The 43 patients who were stabilized and transferred had a median RTS of 5.97 (IQR, 4.30 to 6.90) and an ISS of 18 (IQR, 12 to 25). The median interval in the Level III ED before transfer was 1 hour 43 minutes (IQR, 1 hour 11 minutes to 2 hours 40 minutes). There were two unexpected survivors (Ps = .32, Ps = .49) and 1 unexpected death (Ps = .52). The predicted number of deaths was 8.1, whereas the actual number was 5. The 7 patients who died in the rural Level III ED had a median RTS of 4.41 (IQR, 2.98 to 4.71) and a median ISS of 50 (IQR, 44 to 65). The median interval in the Level III ED before death was 42 minutes (IQR, 41 minutes to 1 hour 20 minutes). There were 2 unexpected deaths (Ps = .66, Ps = .55). The predicted number of deaths was 5.4 whereas the actual number was 7. CONCLUSION: Triage and stabilization of severely injured rural trauma victims at Level III EDs before Level I transfer provide outcomes similar to national results. Unexpected death of severely injured trauma victims remains a problem in rural Level III EDs.

Adolescent↗

PubMed1997

The complications of trauma and their associated costs in a level I trauma center.

OBJECTIVES: To estimate the expected costs for acute trauma care, to quantify the costs associated with the development of complications in injury victims, and to determine the deficit incurred by patients in whom complications develop. DESIGN: A retrospective, cohort design. SETTING: A referral trauma center. PATIENTS: A total of 12,088 patients admitted to a single regional trauma center during a period of 5 years. INTERVENTIONS: This is an observational study, and no interventions specific to this study are included in the design. MAIN OUTCOME MEASURES: (1) The expected costs for injury victims based on readily available clinical data. (2) The costs associated with the most important complications of trauma. (3) The effect of complications on inadequate reimbursement for trauma care. RESULTS: The expected costs were estimated using a linear model incorporating demographic variables and measures of injury severity. The expected costs averaged $14,567, and the observed costs averaged $15,032. Six complications were important predictors of cost. These included adult respiratory distress syndrome, acute kidney failure, sepsis, pneumonia, decubitus ulceration, and wound infections. For 1201 individuals with these complications, the predicted costs averaged $23,266 and the observed costs averaged $47,457. The mean excess costs for a single complication ranged from $6669 to $18,052. Multiple complications led to greater increases in excess cost, averaging $110,007 for the 62 patients with 3 or more complications. Costs exceeded reimbursement to a much greater degree in those in whom any of the 6 complications developed. CONCLUSION: Expected hospital costs can be estimated using admission clinical data. Each of 6 complications was associated with enormous increases in costs, indicating their importance as a cause of avoidable expenditures in injury victims and identifying situations in which reimbursement may not be adequate.

Cohort Studies↗

PubMedDate not supplied

Preparing for hospital site review for trauma center designation: a survey of nurse evaluators.

Trauma nurse experts often are included on the professional teams who survey hospitals for trauma center designation. Evaluation of trauma nursing care includes interviews with staff and review of policies, procedures, and other documents. Medical records are reviewed to validate the verbal reports and examine compliance with protocols. Nursing often provides the "glue" for the system, which integrates medicine, ancillary departments, and administration. Hospitals may use the information gleaned from trauma nurse surveyors to prepare their personnel for a trauma site review.

Humans↗

PubMed2005

The financial impact of delayed discharge at a level I trauma center.

BACKGROUND: Delayed discharge is a costly phenomenon that takes place in every hospital system in the country, with significant operational consequences. The purpose of this study was to identify reasons for delayed discharge and evaluate the financial implications at a Level I trauma center. METHODS: Patients admitted to a Level I trauma center from September 2001 through June 2003 were classified with respect to those who did and did not experience a delay in discharge. RESULTS: For every 25 patients admitted to the trauma center, 1 experienced a delay in discharge, with an average delay of 6 days. The majority of the delays in discharge were attributable to difficulties in patient placement, such as lack of a rehabilitation or subacute hospital bed. Total hospital charges for excess days in the hospital for patients experiencing a delay in discharge were $2,455,703 per year and total costs were $715,403 per year. Patients with delayed discharge tended to be older, female, more severely injured, and more likely to have government-sponsored insurance. CONCLUSION: This study suggests that the main cause of delayed discharge from trauma centers is a consequence of limitations in posthospital care. Strategies must be identified to reduce the barriers to posthospital care to reduce these delays in discharge, lower unnecessary hospital costs, and ensure the financial viability of trauma centers and continuation of clinical services to the communities they serve.

Alabama↗