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 19 recordsLinked to original sources

PubMed1992

Impact of minimal injuries on a level I trauma center.

Overtriage (i.e.; transport of patients with minimal injuries to a trauma center) has been accepted as necessary to avoid missing clinically significant injuries. We reviewed our experience with 344 patients (ISS less than or equal to 4) who were admitted to a level I trauma center during a 2-year period. The trauma team was activated for 209 patients (TA), and emergency department referrals accounted for 135 (ED). One hundred seventy-three patients (TA = 64%, ED = 36%) met American College of Surgeons' Committee on Trauma (ACSCOT) field triage criteria (FTC). Mechanism of injury, especially ejection from a motor vehicle, was the most frequently utilized FTC indicator. We found no differences between the TA and ED groups relative to Trauma Score, Glasgow Coma Scale score, Injury Severity Score, length of stay, or ICU days. Mean total costs were higher for the TA group than for the ED group. The TA group had a higher nursing acuity level than the ED group. Compliance with FTC yields an inherent overtriage of minimally injured patients; however, noncompliance with FTC compounds the overtriage rate. Failure to comply with FTC is costly, labor intensive, and may represent misuse of the trauma system. We propose continual re-education of prehospital personnel, increased responsibility of all hospitals in the trauma center catchment area, and protocols for "downstaging" trauma resuscitation in minimally injured patients.

Adult↗

PubMed1992

Analysis of organ procurement failure at an urban trauma center and the impact of HIV on organ procurement at a regional transplantation center.

A 42-month experience with 100 patients with fatal head injuries was analyzed to identify areas of organ procurement failure. Thirty-six patients were ineligible for organ donation. Reasons for exclusion included advanced age (7), sepsis (16), hepatitis (1), systemic illnesses (3), and HIV infection or risk (9). Resuscitation failure (17 patients) and late deaths from failed support (16 patients) left 31 potential donors. Of the 30 families asked to donate, 17 consented (56.7%). Annual consent rates were 25%, 71%, 75%, and 67%. Efforts to improve organ procurement should focus on resuscitation and physiologic support of potential donors. To assess the impact of HIV infection or risk on organ procurement, a 3-year experience of the regional transplantation center (RTP) was reviewed. Of 1,714 referrals to the RTP from 102 hospitals, 1,120 were from trauma centers. The incidence of rejection because of HIV risk or infection was significantly higher in the trauma center group than in the group from non-trauma centers, 17.2% versus 10.2% (p less than 0.004). A similar difference was noted between metropolitan and suburban hospitals (p less than 0.0001). Hepatitis risk was comparable, 3.9% vs. 3.2%. The risk of HIV infection is emerging as a factor limiting organ donation at urban trauma centers.

Adolescent↗

PubMed1977

Trauma centers: a pragmatic approach to need, cost, and staffing patterns.

Based on the recommendations of the Health Services Administration and the Committee on Trauma of the American College of Surgeons, optimal staffing patterns for a trauma center are unrealistic in cost and personnel needs for all but a few large, urban teaching hospitals. As an alternative, the staffing pattern for a trauma program for a nonuniversity community hospital consists of one general surgeon, an anesthesiologist and one emergency physician. In addition, surgical subspecialists in thoracic surgery, urology, obstetrics and gynecology, ophthalmology, otolaryngology and plastic surgery would be on call within 30 minutes. A paid, part-time program director and paid coordinator of nursing and allied health personnel would be on staff. Need for trauma centers versus trauma programs can be assessed by using 5% of the number of motor vehicle accidents in an area to forecast the number of traumatic injuries. This is done in California as an example.

Accidents, Traffic↗

PubMedDate not supplied

Analysis of motor vehicle crash data in an urban trauma center: implications for nursing practice and research.

OBJECTIVE: To examine the incidence of risk behaviors (safety restraint use and alcohol use) and demographic characteristics of motor vehicle crash victims. DESIGN: Retrospective, descriptive, correlational. SETTING: One major, urban, Level 1 trauma center. SUBJECTS: The medical records of 864 motor vehicle crash victims (drivers, passengers, pedestrians, bicycle riders, and motorcycle riders) admitted to the trauma center between July 1, 1989, and June 30, 1990, were reviewed. RESULTS: Eighty-two percent of motor vehicle occupants (403 drivers and passengers) were not wearing safety restraints at the time of the crash. Thirty-six percent of drivers (92) and 42% (47) of pedestrians were intoxicated on admission to the trauma center. Failure to use safety restraints was associated with alcohol use in this population. Subjects who engaged in risk behaviors were predominantly adolescent and young adult males. CONCLUSIONS: These data suggest the need for further research into correlates of risk behaviors and interventions to prevent future injury related to these behaviors.

Accidents, Traffic↗

PubMed1992

Trauma center closures: a national assessment.

A 1990 national survey of 66 closed trauma centers across 14 states was conducted to ascertain the factors that prompted closure. Data from 44 facilities, or 67% of the centers identified, indicate that inadequate financing and physician participation were commonplace. The findings support the work of other investigators and demonstrate that uncompensated care, inadequate reimbursement, high operating costs, and lack of physician support all adversely affect trauma care in both urban and suburban settings.

Catchment Area, Health↗

PubMed1992

The prevalence of hepatitis C in a regional level I trauma center population.

Several studies have examined the prevalence of hepatitis B (HBV) and human immunodeficiency virus (HIV) in a trauma population. To our knowledge, no one has reported on the prevalence of hepatitis C (HCV). We prospectively studied the prevalence of HCV, as well as HBV, HIV, and syphilis in our adult regional level I trauma center population. Two hundred eighty-six consecutive trauma patients were tested for previous exposure to HCV using an anti-HCV mAb ELISA. Patients were also tested for exposure to HBV, HIV, and syphilis, and for illicit drug use. All rho values were calculated using Yates' corrected chi 2 or Student's t test. Twenty-two patients (7.7%) were found to have anti-HCV antibodies, five patients (1.7%) had active HBV, nine patients (3.2%) had HIV, and 16 patients (6%) were positive by RPR. Four (18%) of the patients seropositive for HCV tested positive for HBV, HIV, or syphilis as well. The HIV-positive patients were more likely than the HIV-negative patients to be HCV positive (rho = 0.018). Nine of the HCV seropositive patients (41%) tested positive for cocaine use. Cocaine users were more likely than nonusers to be HCV positive (rho = 0.0007). We have demonstrated the prevalence of HCV in our trauma population to be high (7.7%). It is well known that HCV has a high rate of chronicity, thus up to 90% of these patients are carriers and represent a substantial risk to health care workers. The two significant risk factors, HIV status and cocaine use, are difficult to elicit in the acute setting, reinforcing the need for adhering to universal precautions.

Cocaine↗

PubMed1977

The salvageability of patients with post-traumatic rupture of the descending thoracic aorta in a primary trauma center.

If uniform early diagnosis is accomplished, two thirds of patients with rupture of the proximal descending aorta seen at a primary trauma treatment center are potentially salvageable. Currently the survival rate is only one half of this optimum figure (31%). One third of 39 patients with acute rupture of the proximal descending thoracic aorta studied had lethal concomitant injuries and were unsalvageable. Twenty-six patients were potentially salvageable; twelve (46%) survived. Eight potential survivors (31%) died because their aortic rupture was not diagnosed or because it was not promptly diagnosed. Eighteen of the potentially salvageable patients (69%) underwent aortic repair; two thirds survived. Aortic rupture was uniformly diagnosed earlier in the more critically injured patients and thus they underwent aortic repair earlier. One half of the 12 patients in whom thoracotomy was instituted within 6 hours of admission survived; six patients who underwent aortic repair more than 6 hours after admission survived.

Adolescent↗

PubMed1976