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The Impact of a Dedicated Trauma Program on Outcome in Severely Injured Patients

The Impact of a Dedicated Trauma Program on Outcome in Severely Injured Patients Abstract Background: In recent years, many trauma centers have been closing or scaling down their operations because of financial losses and lack of commitment by the relevant authorities. Objective: To investigate the effect of commitment to trauma and the establishment of a dedicated trauma program on injury outcome. Design: In 1992, a well-funded dedicated trauma program was implemented at the Los Angeles County—University of Southern California Medical Center, Los Angeles. We analyzed the outcome in severely injured patients (Injury Severity Score [ISS] > 15) before and after implementation of the program (1991 and 1993). Setting: Large, urban, level 1 trauma center. Patients: Patients with trauma and an ISS higher than 15. Results: There were 737 patients with an ISS higher than 15 in 1991 and 812 patients with an ISS higher than 15 in 1993. The overall mortality rate was 30% in 1991 and 24.5% in 1993 (P=.018), which is a reduction by 18.3%. In patients with blunt trauma and an ISS higher than 15, mortality was reduced by 33% (mortality rate of 31.1% in 1991 vs 20.8% in 1993) (P<.002). Mortality in patients with penetrating trauma and an ISS higher than 30 was reduced by 42.7% (mortality rate of 59.3% in 1991 vs 34% in 1993) (P=.019). There was also a trend toward lower permanent disabilities among survivors with an ISS higher than 15 (14.7% in 1991 vs 11.3% in 1993). Conclusion: Commitment of financial and human resources for the establishment of a dedicated trauma program is a sound investment in terms of improved survival and fewer permanent disabilities in critically injured patients.(Arch Surg. 1995;130:216-220) References 1. National Academy of Science. Injury in America: A Continuing Health Problem . Washington, DC: National Academy Press; 1985. 2. Cales RH, Trunkey DD. Preventable trauma deaths: a review of trauma care systems development . JAMA . 1985;254:1059-1063.Crossref 3. Shackford SR, Hollingsworth-Fridlund P, Cooper GF, et al. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report . J Trauma . 1986;26:812-820.Crossref 4. Dailey JT, Teter H, Cowley RA. Trauma center closures: a national assessment . J Trauma . 1992;33:539-549.Crossref 5. West JG, Cales RH, Cazziniga AB. Impact of regionalization: the Orange County experience . Arch Surg . 1983;118:740-744.Crossref 6. Shackford SR, Machersie RC, Hoyt DB, et al. Impact of a trauma system on outcome of severely injured patients . Arch Surg . 1987;122:523-527.Crossref 7. Guss DA, Meyer FT, Neuman TS, et al. The impact of a regionalized trauma system in San Diego County . Ann Emerg Med . 1989;18:1141-1145.Crossref 8. West JG, Trunkey DD, Lim RC. Systems of trauma care: a study of two counties . Arch Surg . 1979;114:455-460.Crossref 9. Voeller GR, Mangiante EC, Fabian TC. The effect of a trauma system on the outcome of patients with pancreatic trauma . Arch Surg . 1991;126:578-580.Crossref 10. Wilson DS, McElligott J, Fielding LP. Identification of preventable trauma deaths: confounded injuries . J Trauma . 1992;32:45-54.Crossref 11. Kane G, Wheeler NC, Cook S, et al. Impact of the Los Angeles County Trauma System on the survival of seriously injured patients . J Trauma . 1992;32:576-583.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Impact of a Dedicated Trauma Program on Outcome in Severely Injured Patients

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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430020106020
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: In recent years, many trauma centers have been closing or scaling down their operations because of financial losses and lack of commitment by the relevant authorities. Objective: To investigate the effect of commitment to trauma and the establishment of a dedicated trauma program on injury outcome. Design: In 1992, a well-funded dedicated trauma program was implemented at the Los Angeles County—University of Southern California Medical Center, Los Angeles. We analyzed the outcome in severely injured patients (Injury Severity Score [ISS] > 15) before and after implementation of the program (1991 and 1993). Setting: Large, urban, level 1 trauma center. Patients: Patients with trauma and an ISS higher than 15. Results: There were 737 patients with an ISS higher than 15 in 1991 and 812 patients with an ISS higher than 15 in 1993. The overall mortality rate was 30% in 1991 and 24.5% in 1993 (P=.018), which is a reduction by 18.3%. In patients with blunt trauma and an ISS higher than 15, mortality was reduced by 33% (mortality rate of 31.1% in 1991 vs 20.8% in 1993) (P<.002). Mortality in patients with penetrating trauma and an ISS higher than 30 was reduced by 42.7% (mortality rate of 59.3% in 1991 vs 34% in 1993) (P=.019). There was also a trend toward lower permanent disabilities among survivors with an ISS higher than 15 (14.7% in 1991 vs 11.3% in 1993). Conclusion: Commitment of financial and human resources for the establishment of a dedicated trauma program is a sound investment in terms of improved survival and fewer permanent disabilities in critically injured patients.(Arch Surg. 1995;130:216-220) References 1. National Academy of Science. Injury in America: A Continuing Health Problem . Washington, DC: National Academy Press; 1985. 2. Cales RH, Trunkey DD. Preventable trauma deaths: a review of trauma care systems development . JAMA . 1985;254:1059-1063.Crossref 3. Shackford SR, Hollingsworth-Fridlund P, Cooper GF, et al. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report . J Trauma . 1986;26:812-820.Crossref 4. Dailey JT, Teter H, Cowley RA. Trauma center closures: a national assessment . J Trauma . 1992;33:539-549.Crossref 5. West JG, Cales RH, Cazziniga AB. Impact of regionalization: the Orange County experience . Arch Surg . 1983;118:740-744.Crossref 6. Shackford SR, Machersie RC, Hoyt DB, et al. Impact of a trauma system on outcome of severely injured patients . Arch Surg . 1987;122:523-527.Crossref 7. Guss DA, Meyer FT, Neuman TS, et al. The impact of a regionalized trauma system in San Diego County . Ann Emerg Med . 1989;18:1141-1145.Crossref 8. West JG, Trunkey DD, Lim RC. Systems of trauma care: a study of two counties . Arch Surg . 1979;114:455-460.Crossref 9. Voeller GR, Mangiante EC, Fabian TC. The effect of a trauma system on the outcome of patients with pancreatic trauma . Arch Surg . 1991;126:578-580.Crossref 10. Wilson DS, McElligott J, Fielding LP. Identification of preventable trauma deaths: confounded injuries . J Trauma . 1992;32:45-54.Crossref 11. Kane G, Wheeler NC, Cook S, et al. Impact of the Los Angeles County Trauma System on the survival of seriously injured patients . J Trauma . 1992;32:576-583.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1995

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