Israel et Peleg !
France et . . . ? ? ?
----- Original Message -----
From: "Karim Brohi" <[EMAIL PROTECTED]>
To: "'Trauma & Critical Care mailing list'" <[EMAIL PROTECTED]>
Sent: Tuesday, November 16, 2004 1:15 AM
Subject: Effective Trauma System in Israel
This paper is in this months Archives of Surgery. At least 3 of the
authors are trauma-list members.
Increased Survival Among Severe Trauma Patients: The Impact of a
National Trauma System
It's an impressive piece of work, for all sorts of reasons. Full
text is enclosed
Karim
Increased Survival Among Severe Trauma Patients
The Impact of a National Trauma System
Kobi Peleg, PhD, MPH; Limor Aharonson-Daniel, PhD; Michael Stein, MD;
Yoram Kluger, MD; Moshe Michaelson, MD; Avraham Rivkind, MD;
Valentina Boyko, MSc; the Israel Trauma Group
Arch Surg. 2004;139:1231-1236.
Hypothesis The survival of severe trauma patients is affected by the
implementation of a national trauma system, which brought about
developments both at the hospital and prehospital levels during the
past decade.
Design A retrospective cohort study of all severely injured patients
(Injury Severity Score >16) recorded in the Israeli National Trauma
Registry at all level I trauma centers in Israel from January 1,
1997, to December 31, 2001. Inpatient death rates were examined
overall and by subgroups.
Setting The National Trauma Registry includes trauma (International
Statistical Classification of Diseases, 9th Revision, Clinical
Modification diagnosis codes 800-959) hospitalizations, patients who
were transferred to or from other hospitals, and those who died in
the emergency department. It excludes patients who were dead on
arrival, discharged following treatment in the emergency department,
and patients who do not fall into the definition of trauma.
Main Outcome Measure Inpatient death.
Results Seven thousand four hundred twenty-three severe trauma
patients were recorded. Inpatient death rates decreased significantly
from 21.6% in 1997 to 14.7% in 2001. The odds ratios of mortality in
1998 through 2001 vs 1997, adjusted for year, age, sex, penetrating
injury, and severity of injury (Injury Severity Score >25), were
0.92, 0.89, 0.70, and 0.65, respectively, confirming the downward
trend.
Conclusions A steady significant reduction in the inpatient death
rate of severe trauma patients hospitalized at all level I trauma
centers in Israel between 1997 and 2001 was observed. Although a
single factor that explains the reduction was not identified, it is
evident that the establishment of the trauma system brought about a
significant decrease in mortality. We believe that integrated
cooperation of various components of the national trauma system in
Israel across the years may explain the reduction.
. . . . . . . .
Hello Karim,
Finally some comfort after all the long years of daily hard work.
The
system is still far from perfect but we think we have shown that
intervention changes outcome on a statewide level. The years 2002 &
2003 continue the downward trend and drop in death rate from major
trauma ("personal communication"). In my opinion it is even more
impressive, since during those years the efficiency of the EMS system
has improved tremendously (partly because of experience with
management of terror incidents). Therefore, we are witnessing an
increased number of sicker trauma victims that previously never
survived the prehospital travel.
Hundreds !! of providers are responsible for this change and they all
deserve the credit.
Mickey
*************************************************
Michael Stein MD
Chairman, Israel Trauma Society
Director of Trauma, Attending Surgeon,
Department of Surgery,
The Rabin Medical Center, Beilinson Campus,
Petach-Tikva, 49100
Israel
Cellular: +972 50-763-7752
Tel: +972 3-937-7043
Fax: +972 3-937-7042
E-Mail: [EMAIL PROTECTED]
*************************************************
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