Inclusive trauma systems: do they improve triage or outcomes of the severely injured?

The Journal of Trauma
Garth H UtterAvery B Nathens

Abstract

Trauma systems decrease injury-related mortality, but not all systems have the same configuration. In some systems, nearly all acute care hospitals participate to the extent that their resources allow (inclusive systems), whereas in others, relatively few high-level centers participate (exclusive systems). We postulate that inclusive systems assure that severely injured patients are more likely to be triaged to a level I or II regional trauma center, and this greater degree of participation would lead to lower mortality. We used administrative discharge data for 2001 in 24 states with formal systems, and we included all urgently hospitalized adults with an Injury Severity Score>or=16. We categorized states by trauma system configuration ("exclusive", "more inclusive", "most inclusive") based on the proportion of all hospitals designated as a Level I through V trauma center (0-13%, 14-37%, 38-100%, respectively). We compared the rates of triage to a regional trauma center and inpatient death in inclusive states relative to exclusive states, while adjusting for patient- and state-level factors. Out of 61,496 patients, 40,706 (66.2%) were hospitalized at regional trauma centers. Inpatient mortality was 14.7%. After adjusting for p...Continue Reading

References

Jan 1, 1989·American Journal of Epidemiology·R M Mickey, S Greenland
Oct 1, 1995·American Journal of Surgery·C W KonvolinkaW J Sacco
Jan 1, 1995·The Journal of Trauma·G J Bazzoli, E J MacKenzie
Apr 27, 1999·The Journal of Trauma·N C MannR J Mullins
Sep 25, 1999·The Journal of Trauma·N C MannC N Mock
Sep 25, 1999·The Journal of Trauma·N A Atweh
May 2, 2000·JAMA : the Journal of the American Medical Association·A B NathensR V Maier
Mar 20, 2001·JAMA : the Journal of the American Medical Association·A B NathensF P Rivara
Jun 5, 2002·The Journal of Trauma·Richard J MullinsGregory J Jurkovich
Apr 4, 2003·JAMA : the Journal of the American Medical Association·Ellen J MacKenzieHarry Teter

❮ Previous
Next ❯

Citations

Nov 20, 2013·Annales Françaises D'anesthèsie Et De Rèanimation·P BouzatJ-F Payen
Dec 17, 2009·Annals of Surgery·Minke J TwijnstraLuke P H Leenen
Jun 10, 2010·Annals of Surgery·Joseph P MineiUNKNOWN Resuscitation Outcome Consortium Investigators
Jul 12, 2007·The Journal of Trauma·Glen H TinkoffMary Sue Jones
May 12, 2009·The Journal of Trauma·Michael T CudnikSteven M Steinberg
Nov 15, 2011·BMC Medicine·Nikolaos K Kanakaris, Peter V Giannoudis
Apr 22, 2010·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Kristin T LarsenEirik Skogvoll
May 9, 2012·Canadian Journal of Surgery. Journal Canadien De Chirurgie·Nathaniel BellStephen Wheeler
Jan 25, 2012·Canadian Journal of Surgery. Journal Canadien De Chirurgie·John M TallonDavid Petrie
Jul 10, 2010·International Journal of Environmental Research and Public Health·Nathaniel Bell, Nadine Schuurman
Jun 3, 2011·Journal of Emergencies, Trauma, and Shock·Rachid AminiMarcel Emond
Nov 28, 2012·International Journal of Critical Illness and Injury Science·Amelia J SimpsonTam N Pham
Jan 20, 2010·Langenbeck's Archives of Surgery·Georgios F GiannakopoulosGerrolt N Jukema
Nov 3, 2007·Current Opinion in Critical Care·Koen W W Lansink, Luke P H Leenen
Dec 21, 2012·World Journal of Surgery·Timothy Craig HardcastleDavid James Jackson Muckart
Jul 31, 2013·Surgery·David J CieslaLewis M Flint
Mar 31, 2011·Journal of the American College of Surgeons·David C ChangRaul Coimbra
Jan 26, 2010·Medicina intensiva·E Alted López
Dec 15, 2007·Current Problems in Surgery·Robert C Mackersie, Rochelle A Dicker
Dec 18, 2007·American Journal of Surgery·David J CieslaMarion H Jordan
Dec 25, 2007·Journal of the American College of Surgeons·David J CieslaMarion H Jordan
Nov 28, 2006·The Surgical Clinics of North America·David B Hoyt, Raul Coimbra
Mar 11, 2016·Brain Injury : [BI]·Stephen C GalePaul W Detwiler
Nov 13, 2014·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Oddvar UlebergPål Klepstad
Sep 4, 2015·The Journal of Trauma and Acute Care Surgery·Jan O JansenMarion K Campbell
Sep 30, 2009·The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association·Melanie ArthurJerris R Hedges
Jul 23, 2008·The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association·Michelle M CaseyIra S Moscovice
Dec 12, 2012·Anaesthesia·R A Lendrum, D J Lockey
Dec 3, 2010·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Abhishek MehrotraR Myles Riner
Apr 5, 2013·The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association·Hayden L Smith, Richard A Sidwell
Apr 17, 2016·American Journal of Surgery·Hayden L SmithRichard A Sidwell
Dec 17, 2009·The British Journal of Surgery·R A DavenportK Brohi
Jun 8, 2012·The Journal of Trauma and Acute Care Surgery·Ofer AmramS Morad Hameed
Dec 15, 2010·American Journal of Surgery·Craig O DanielRonald M Stewart
Aug 8, 2015·Anaesthesia Critical Care & Pain Medicine·Hervé QuintardUNKNOWN Emergency Intensive Care Group of the French Society of Anesthesiology, Intensive Care (Sociéte française d’anesthésie et de
Jun 13, 2015·The American Journal of Emergency Medicine·Brian P VickersHuiyun Xiang
Sep 8, 2015·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·I BalasubramanianD C Winter
Feb 6, 2015·World Journal of Surgery·Lynne MooreJean Lapointe
Jul 6, 2014·The American Journal of Emergency Medicine·Huiyun XiangKathryn Jo Haley
Apr 10, 2012·Injury·Gerard M O'ReillyManjul Joshipura
Feb 14, 2012·The Journal of Trauma and Acute Care Surgery·Alex J VanniBryan B Voelzke
May 11, 2016·Journal of Pediatric Surgery·Jill DreyfusAnupam Kharbanda

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.