Do designated trauma systems improve outcome?

Current Opinion in Critical Care

Volumn 13, Issue 6, 2007, Pages 686-690

  Lansink, Koen W W ^a   Leenen, Luke P H ^a  

^a UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

Author keywords

Inclusive; Performance outcome; Trauma center; Trauma registry; Trauma system; Triage

Indexed keywords

EMERGENCY HEALTH SERVICE; HUMAN; INJURY; INJURY SEVERITY; OUTCOME ASSESSMENT; QUALITY OF LIFE; REGISTER; REVIEW; SURVIVAL RATE;

HUMANS; NETHERLANDS; TRAUMA CENTERS; TRAUMA SEVERITY INDICES; TRAUMATOLOGY; TREATMENT OUTCOME; TRIAGE; WOUNDS AND INJURIES;

EID: 35848963365     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e3282f1e7a4     Document Type: Review

References (24)

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4. Position paper on trauma care systems. Third National Injury Control Conference April 22-25, 1991, Denver, Colorado. J Trauma 1992; 32:127-129.
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8. Celso B, Tepas J, Langland-Orban B, et al. A systematic review and metaanalysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma 2006; 60:371-378. This is a very good meta-analysis of the existing literature on trauma systems consisting of 14 articles from which eight had shown a positive effect of trauma system institution. The positive effect on mortality appeared to be 15% on average after trauma system institution.
9. Utter GH, Maier RV, Rivara FP, et al. Inclusive trauma systems: do they improve triage or outcomes of the severely injured? J Trauma 2006; 60:529-535. Utter and co-workers compared the measure of inclusiveness of the system instituted and were the first to show that an inclusive system has benefits over a noninclusive system.
10. Papa L, Langland-Orban B, Kallenborn C, et al. Assessing effectiveness of a mature trauma system: Association of trauma center presence with lower injury mortality rate. J Trauma 2006; 61:261-266. This population-based study on mortality from motor vehicle crashes comparied counties with and without a trauma center. The case-fatality rate is significantly lower in counties with a trauma center.
11. Mackenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006; 354:366-378. MacKenzie and co-workers researched in a nationwide study with over 5000 patients and a death rate of approximately 20% the question of whether maintaining trauma centers is worthwhile. A total of 18 trauma centers and 51 nontrauma centers in 14 states were involved. They conclude that the risk of death in a trauma center is significantly lower (RR 0.80) than in a nontrauma center. At 1 year this risk reduction is even higher (RR 0.75).
12. Durham R, Pracht E, Orban B, et al. Evaluation of a mature trauma system. Ann Surg 2006; 243:775-783. Durham and co-workers reviewed based on ICD-9 codes the Florida trauma system, a mature system in the US and compared trauma with nontrauma center admissions. They found that triage to a Florida trauma center is associated with a decreased risk of death. Whereas the cost/life year saved is favorable when compared with societal expenditures for other health problems. Improved deployment of trauma centers is necessary to optimize access. In addition they demonstrated that this kind of assessment is feasible for evaluation of mature trauma systems.
13. Osterwalder JJ. Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A prospective cohort study. J Trauma 2002; 52:1030-1036.
14. Nicholl J, Turner J. Effectiveness of a regional trauma system in reducing mortality from major trauma: before and after study 7. BMJ 1997; 315:1349-1354.
15. Nathens AB, Brunet FP, Maier RV. Development of trauma systems and effect on outcomes after injury. Lancet 2004; 363:1794-1801.
16. Clark DE, Anderson KL, Hahn DR. Evaluating an inclusive trauma system using linked population-based data. J Trauma 2004; 57:501-509.
17. Sturms LM, Hoogeveen JM, Le CS, et al. Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry. Langenbecks Arch Surg 2006; 391:343-349. In this study triage criteria were evaluated after the institution of a trauma system in the Netherlands. It demonstrated the effect of triage in that indeed the most severely injured patients were managed in the trauma center. A low sensitivity for the T-RTS was found, however: a reason to advise to reevaluate this tool in future.
18. Epley EE, Stewart RM, Love P, et al. A regional medical operations center improves disaster response and inter-hospital trauma transfers. Am J Surg 2006; 192:853-859.
19. Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of errors contributing to trauma mortality: lessons learned from 2594 deaths. Ann Surg 2006; 244:371-380. Even a mature trauma system has to rely on procedures to reveal errors which can be prevented in the daily care of the traumatized patient. In an overview of medium to low probability deaths in a mature trauma center environment of Harbourview hospital, a level one trauma center for many years, the authors revealed that preventable deaths will occur even in mature trauma systems. This review has identified error patterns that are likely common in all trauma systems, and for which policy interventions can be effectively targeted.
20. Aylwin CJ, Konig TC, Brennan NW, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet 2006; 368:2219-2225.
21. Probst C, Paffrath T, Krettek C, Pape HC. Comparative update on documentation of trauma in seven national registries. European Journal of Trauma 2006; 32:357-364.
22. Cameron PA, Gabbe BJ, McNeil JJ. The importance of quality of survival as an outcome measure for an integrated trauma system. Injury 2006; 37:1178-1184. This article details the necessity of more than alone mortality data in the evaluation of trauma systems. It reveals the first experiences with outcome data, other than risk adjusted mortality rates, in Australia.
23. van Beeck EF, Larsen CF, Lyons RA, et al. Guidelines for the conduction of follow-up studies measuring injury-related disability. J Trauma 2007; 62:534-550. As in the preceding reference this article details the necessity of more than alone mortality data in the evaluation of trauma systems and does a proposal based on an extensive literature review of empirical studies into injury related disability which comprises EQ-5D, the Health Utilities Mark III and an injury specific scale.
24. Nirula R, Brasel K. Do trauma centers improve functional outcomes: a national trauma databank analysis? J Trauma 2006; 61:268-271.