URG-L: System de Trauma

[Charles Brault]

 

 

Trauma-center care cuts death risk
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A Johns Hopkins University and University of Washington study indicates trauma-center care lowers by 25 percent the risk of death for injured patients.

The nationwide study was conducted by researchers at the Johns Hopkins University Bloomberg School of Public Health and the University of Washington School of Medicine.

Researchers say the study is among the first to provide strong evidence of the effectiveness of specialized trauma-care facilities.

"Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. Now we have conclusive data to show that trauma care is effective," said the study's lead author, Ellen MacKenzie, chairwoman of the Department of Health Policy and Management at the Bloomberg school.

"The findings of this study argue strongly for continued efforts at regionalizing trauma care at the state and local levels to assure that patients who suffer serious injuries get to a trauma center where they are afforded the best possible care."

The study is detailed in the Jan. 26 edition of the New England Journal of Medicine.

Jan 26, 2006

 

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Access to Trauma Centers Often Inadequate, Inefficient
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Nearly 50 millions Americans do not have access to a level I or II trauma center within an hour if they were to be seriously injured, according to a study in the June 1 issue of JAMA.

Despite the growing number of trauma centers over the past decade, studies indicate that their geographic distribution varies widely across states, according to background information in the article. These studies suggest that residents in many parts of the country are without timely access to trauma centers that could save their lives. In other parts of the country, there are possibly too many trauma centers that may lead to inefficiencies, reduced quality of care, and lower patient volumes per center.

Charles C. Branas, Ph.D., from the University of Pennsylvania School of Medicine, Philadelphia, and colleagues used information from two national databases to estimate U.S. residents’ access to level I, II, and III trauma centers by ground ambulance or helicopter within 45 and 60 minutes. “Level I and II trauma centers provide comprehensive care for the most critically injured patients and have immediate availability of trauma surgeons, anesthesiologists, and certain other physician specialists,” the article states. “Level III centers provide prompt assessment, resuscitation, surgery, and stabilization, with transfer to a level I or II center when indicated.”

The researchers found that an estimated 69.2 percent and 84.1 percent of U.S. residents had access to a level I or II trauma center within 45 and 60 minutes, respectively. Residents in the northeastern region of the U.S. had the greatest access to level I and II centers within 45 and 60 minutes, with accessibility at 85.8 percent and 96.9 percent, respectively. The 46.7 million people who did not have access within an hour of trauma care generally lived in rural areas, while the 42.8 million people who had access to 20 or more level I or II trauma centers within an hour lived mostly in urban areas. Only about ten percent and 25 percent of U.S. land area was located within 45 and 60 minutes, respectively, of a level I or II trauma center.

“Judiciously selecting trauma centers based on geographic need, appropriately locating medical helicopter bases, and establishing formal agreements for sharing trauma care resources across states should be considered to improve access to trauma care in the United States,” the authors conclude.

(JAMA. 2005; 293: 2626 – 2633. http://jama.ama-assn.org/cgi/content/short/293/21/2626

Jun 1, 2005

 

 

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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.