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Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems.

Gunning AC, Lansink KW, van Wessem KJ, Balogh ZJ, Rivara FP, Maier RV, Leenen LP - World J Surg (2015)

Bottom Line: HMC compared to JHH was 1.002 (95 % CI 0.664-1.514).Odds of death patients ISS > 15: JHH = 0.507 (95 % CI 0.300-0.857) and HMC = 0.451 (95 % CI 0.297-0.683) compared to UMCU.HMC = 0.931 (95 % CI 0.608-1.425) compared to JHH.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. a.c.gunning@umcutrecht.nl.

ABSTRACT

Introduction: Trauma systems were developed to improve the care for the injured. The designation and elements comprising these systems vary across countries. In this study, we have compared the demographic patterns and patient outcomes of Level I trauma centers in three international trauma systems.

Methods: International multicenter prospective trauma registry-based study, performed in the University Medical Center Utrecht (UMCU), Utrecht, the Netherlands, John Hunter Hospital (JHH), Newcastle, Australia, and Harborview Medical Center (HMC), Seattle, the United States.

Inclusion: patients ≥18 years, admitted in 2012, registered in the institutional trauma registry.

Results: In UMCU, JHH, and HMC, respectively, 955, 1146, and 4049 patients met the inclusion criteria of which 300, 412, and 1375 patients with Injury Severity Score (ISS) > 15. Mean ISS was higher in JHH (13.5; p < 0.001) and HMC (13.4; p < 0.001) compared to UMCU (11.7). Unadjusted mortality: UMCU = 6.5 %, JHH = 3.6 %, and HMC = 4.8 %. Adjusted odds of death: JHH = 0.498 [95 % confidence interval (CI) 0.303-0.818] and HMC = 0.473 (95 % CI 0.325-0.690) compared to UMCU. HMC compared to JHH was 1.002 (95 % CI 0.664-1.514). Odds of death patients ISS > 15: JHH = 0.507 (95 % CI 0.300-0.857) and HMC = 0.451 (95 % CI 0.297-0.683) compared to UMCU. HMC = 0.931 (95 % CI 0.608-1.425) compared to JHH. TRISS analysis: UMCU: Ws = 0.787, Z = 1.31, M = 0.87; JHH, Ws = 3.583, Z = 6.7, M = 0.89; HMC, Ws = 3.902, Z = 14.6, M = 0.84.

Conclusion: This study demonstrated substantial differences across centers in patient characteristics and mortality, mainly of neurological cause. Future research must investigate whether the outcome differences remain with nonfatal and long-term outcomes. Furthermore, we must focus on the development of a more valid method to compare systems.

No MeSH data available.


Related in: MedlinePlus

Flowchart of patients included for analysis. 1Inclusion: Full Trauma Activation or injury severity score >15. 2Exclusion: ≥65 years + isolated neck of femur fracture
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Fig1: Flowchart of patients included for analysis. 1Inclusion: Full Trauma Activation or injury severity score >15. 2Exclusion: ≥65 years + isolated neck of femur fracture

Mentions: An overview of the study patients is shown in Fig. 1. In total, 955 patients met the inclusion criteria from UMCU, 1146 patients from JHH, and 4049 patients from HMC. Patients in UMCU were slightly older, more likely to be female and had longer hospital lengths of stay. Penetrating trauma was more common at HMC compared to UMCU (p < 0.001) and JHH (p < 0.001). Compared to the UMCU population mean, ISS was higher in both JHH (p < 0.001) and HMC (p < 0.001). The proportion of patients with neurotrauma was highest in JHH followed by UMCU and HMC. UMCU had the highest proportion of patients with severe neurotrauma. Almost 50 % of the patients in HMC were admitted to the ICU in contrast to 20.6 % in UMCU and 15.8 % in JHH. Though the ICU patients in UMCU and JHH were more severely injured [median ISS, respectively, 21 (13–27) and 25 (17–34)] compared to HMC [median ISS 17 (10–26)]. Unadjusted mortality was significantly higher at UMCU compared to JHH and HMC. All these patient characteristics are presented in Table 2.Fig. 1


Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems.

Gunning AC, Lansink KW, van Wessem KJ, Balogh ZJ, Rivara FP, Maier RV, Leenen LP - World J Surg (2015)

Flowchart of patients included for analysis. 1Inclusion: Full Trauma Activation or injury severity score >15. 2Exclusion: ≥65 years + isolated neck of femur fracture
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591196&req=5

Fig1: Flowchart of patients included for analysis. 1Inclusion: Full Trauma Activation or injury severity score >15. 2Exclusion: ≥65 years + isolated neck of femur fracture
Mentions: An overview of the study patients is shown in Fig. 1. In total, 955 patients met the inclusion criteria from UMCU, 1146 patients from JHH, and 4049 patients from HMC. Patients in UMCU were slightly older, more likely to be female and had longer hospital lengths of stay. Penetrating trauma was more common at HMC compared to UMCU (p < 0.001) and JHH (p < 0.001). Compared to the UMCU population mean, ISS was higher in both JHH (p < 0.001) and HMC (p < 0.001). The proportion of patients with neurotrauma was highest in JHH followed by UMCU and HMC. UMCU had the highest proportion of patients with severe neurotrauma. Almost 50 % of the patients in HMC were admitted to the ICU in contrast to 20.6 % in UMCU and 15.8 % in JHH. Though the ICU patients in UMCU and JHH were more severely injured [median ISS, respectively, 21 (13–27) and 25 (17–34)] compared to HMC [median ISS 17 (10–26)]. Unadjusted mortality was significantly higher at UMCU compared to JHH and HMC. All these patient characteristics are presented in Table 2.Fig. 1

Bottom Line: HMC compared to JHH was 1.002 (95 % CI 0.664-1.514).Odds of death patients ISS > 15: JHH = 0.507 (95 % CI 0.300-0.857) and HMC = 0.451 (95 % CI 0.297-0.683) compared to UMCU.HMC = 0.931 (95 % CI 0.608-1.425) compared to JHH.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. a.c.gunning@umcutrecht.nl.

ABSTRACT

Introduction: Trauma systems were developed to improve the care for the injured. The designation and elements comprising these systems vary across countries. In this study, we have compared the demographic patterns and patient outcomes of Level I trauma centers in three international trauma systems.

Methods: International multicenter prospective trauma registry-based study, performed in the University Medical Center Utrecht (UMCU), Utrecht, the Netherlands, John Hunter Hospital (JHH), Newcastle, Australia, and Harborview Medical Center (HMC), Seattle, the United States.

Inclusion: patients ≥18 years, admitted in 2012, registered in the institutional trauma registry.

Results: In UMCU, JHH, and HMC, respectively, 955, 1146, and 4049 patients met the inclusion criteria of which 300, 412, and 1375 patients with Injury Severity Score (ISS) > 15. Mean ISS was higher in JHH (13.5; p < 0.001) and HMC (13.4; p < 0.001) compared to UMCU (11.7). Unadjusted mortality: UMCU = 6.5 %, JHH = 3.6 %, and HMC = 4.8 %. Adjusted odds of death: JHH = 0.498 [95 % confidence interval (CI) 0.303-0.818] and HMC = 0.473 (95 % CI 0.325-0.690) compared to UMCU. HMC compared to JHH was 1.002 (95 % CI 0.664-1.514). Odds of death patients ISS > 15: JHH = 0.507 (95 % CI 0.300-0.857) and HMC = 0.451 (95 % CI 0.297-0.683) compared to UMCU. HMC = 0.931 (95 % CI 0.608-1.425) compared to JHH. TRISS analysis: UMCU: Ws = 0.787, Z = 1.31, M = 0.87; JHH, Ws = 3.583, Z = 6.7, M = 0.89; HMC, Ws = 3.902, Z = 14.6, M = 0.84.

Conclusion: This study demonstrated substantial differences across centers in patient characteristics and mortality, mainly of neurological cause. Future research must investigate whether the outcome differences remain with nonfatal and long-term outcomes. Furthermore, we must focus on the development of a more valid method to compare systems.

No MeSH data available.


Related in: MedlinePlus