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Impact of a Trauma System on Outcome of Severely Injured Patients

Impact of a Trauma System on Outcome of Severely Injured Patients Abstract • We examined the impact of a trauma system on the survival of patients with a Trauma Score of 8 or less. We compared the observed survival with that predicted using a method that calculates the probability of survival (Ps) based on age, physiologic score, and anatomic severity of injury. Of 3394 patients triaged to trauma centers in a 12-month period, 283 (8.3%) had a Trauma Score of 8 or less. Sufficient data were available in 189 patients with blunt trauma to make the survival comparison. The Ps was 18%; the observed survival was 29%. Of 60 patients with penetrating trauma and complete data, the Ps was 8%; the observed survival was 20%. We attribute the improved survival to the integration of prehospital and hospital care and expeditious surgery. (Arch Surg 1987;122:523-527) References 1. 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 2. Cales RH, Trunkey DD: Preventable trauma deaths: A review of trauma care systems development . JAMA 1985;254:1059-1063.Crossref 3. Cales RH: Trauma mortality in Orange County: The effect of implementation of a regional trauma system . Ann Emerg Med 1984;13:15-23.Crossref 4. West JG, Trunkey DD, Lim RC: Systems of trauma care: A study of two counties . Arch Surg 1979;114:455-460.Crossref 5. Trauma Needs Assessment Study, San Diego County . Los Angeles, Hospital Council of San Diego and Amherst Associates Inc, (Dec 10) , 1982. 6. Champion HR, Sacco WJ, Carnazzo AJ: Trauma score . Crit Care Med 1981;9:672-676.Crossref 7. American College of Surgeons Committee on Trauma: Hospital and prehospital resources for optimal care of the injured patient . Bull Am Coll Surg 1983;68:11-18. 8. Gormican SP: CRAMS scale: Field triage of trauma victims . Ann Emerg Med 1982;11:132-138.Crossref 9. Moreau M, Gainer PS, Champion HR, et al: Application of the Trauma Score in the prehospital setting . Ann Emerg Med 1985;14:1049-1054.Crossref 10. Baker SP, O'Neill B, Haddon W, et al: The Injury Severity Score . J Trauma 1974;14:187-196.Crossref 11. Shackford SR, Hollingsworth-Fridlund P, McArdle M, et al: Assuring quality in a trauma system: The medical audit committee . J Trauma 1986;26:683.Crossref 12. West JG: The autopsy method for evaluating trauma care . J Trauma 1981;21:32-34.Crossref 13. American College of Surgeons Committee on Trauma: Quality assessment and assurance in trauma care . Bull Am Coll Surg 1986;71:4-23. 14. Champion HR: Major trauma outcome study: Bulletin to participants. February 1986. 15. Champion HR, Frey CF, Sacco WJ: Determination of national normative outcomes for trauma . J Trauma 1984;24:651. 16. Champion HR: Major trauma outcome study: Bulletin to participants. February 1985. 17. Flora JD: A method for comparing survival of burn patients to a standard survival curve . J Trauma 1978;18:701-705.Crossref 18. Committee on Trauma, National Research Council: Accidental Death and Disability: The Neglected Disease of Modern Society . Washington, DC, National Academy of Sciences/National Research Council, 1966. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400170029003
Publisher site
See Article on Publisher Site

Abstract

Abstract • We examined the impact of a trauma system on the survival of patients with a Trauma Score of 8 or less. We compared the observed survival with that predicted using a method that calculates the probability of survival (Ps) based on age, physiologic score, and anatomic severity of injury. Of 3394 patients triaged to trauma centers in a 12-month period, 283 (8.3%) had a Trauma Score of 8 or less. Sufficient data were available in 189 patients with blunt trauma to make the survival comparison. The Ps was 18%; the observed survival was 29%. Of 60 patients with penetrating trauma and complete data, the Ps was 8%; the observed survival was 20%. We attribute the improved survival to the integration of prehospital and hospital care and expeditious surgery. (Arch Surg 1987;122:523-527) References 1. 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 2. Cales RH, Trunkey DD: Preventable trauma deaths: A review of trauma care systems development . JAMA 1985;254:1059-1063.Crossref 3. Cales RH: Trauma mortality in Orange County: The effect of implementation of a regional trauma system . Ann Emerg Med 1984;13:15-23.Crossref 4. West JG, Trunkey DD, Lim RC: Systems of trauma care: A study of two counties . Arch Surg 1979;114:455-460.Crossref 5. Trauma Needs Assessment Study, San Diego County . Los Angeles, Hospital Council of San Diego and Amherst Associates Inc, (Dec 10) , 1982. 6. Champion HR, Sacco WJ, Carnazzo AJ: Trauma score . Crit Care Med 1981;9:672-676.Crossref 7. American College of Surgeons Committee on Trauma: Hospital and prehospital resources for optimal care of the injured patient . Bull Am Coll Surg 1983;68:11-18. 8. Gormican SP: CRAMS scale: Field triage of trauma victims . Ann Emerg Med 1982;11:132-138.Crossref 9. Moreau M, Gainer PS, Champion HR, et al: Application of the Trauma Score in the prehospital setting . Ann Emerg Med 1985;14:1049-1054.Crossref 10. Baker SP, O'Neill B, Haddon W, et al: The Injury Severity Score . J Trauma 1974;14:187-196.Crossref 11. Shackford SR, Hollingsworth-Fridlund P, McArdle M, et al: Assuring quality in a trauma system: The medical audit committee . J Trauma 1986;26:683.Crossref 12. West JG: The autopsy method for evaluating trauma care . J Trauma 1981;21:32-34.Crossref 13. American College of Surgeons Committee on Trauma: Quality assessment and assurance in trauma care . Bull Am Coll Surg 1986;71:4-23. 14. Champion HR: Major trauma outcome study: Bulletin to participants. February 1986. 15. Champion HR, Frey CF, Sacco WJ: Determination of national normative outcomes for trauma . J Trauma 1984;24:651. 16. Champion HR: Major trauma outcome study: Bulletin to participants. February 1985. 17. Flora JD: A method for comparing survival of burn patients to a standard survival curve . J Trauma 1978;18:701-705.Crossref 18. Committee on Trauma, National Research Council: Accidental Death and Disability: The Neglected Disease of Modern Society . Washington, DC, National Academy of Sciences/National Research Council, 1966.

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1987

References