Effect of Trauma Center Designation on Outcome in Patients With Severe Traumatic Brain Injury

DuBose, Joseph J.; Browder, Timothy; Inaba, Kenji; Teixeira, Pedro G.R.; Chan, Linda S.; Δημητριάδης, Δημήτριος

doi:10.1001/archsurg.143.12.1213

Cited by 93 publications

(101 citation statements)

References 22 publications

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“…Most studies evaluating differences across centres caring for such patients have focused on comparing the impact of specific management interventions, specific factors or the designation of the trauma centre on outcomes. [18][19][20][21] In our study, variation in mortality following withdrawal of life-sustaining therapy is of great clinical relevance when one considers that people who acquire a severe traumatic brain injury are often young and have few or no comorbidities. Furthermore, in this specific population of patients, the decision to withdraw life -sustaining therapy made by patients' relatives and medical teams is mainly based on prognostic information.…”

Section: Discussionmentioning

confidence: 98%

Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study

Turgeon

Lauzier²,

Simard³

et al. 2011

CMAJ

354

277

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Section: Discussionmentioning

confidence: 98%

Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study

Turgeon

Lauzier²,

Simard³

et al. 2011

CMAJ

354

277

View full text Add to dashboard Cite

“…7,15 The low prevalence of major trauma in civilians and the consequent lack of experience are considered to be the main causes of inferior outcomes of victims of major trauma in the UK in comparison with other countries, 6,14,16 an observation that has motivated this reform. Designation of trauma centres has been shown to significantly improve the care of critically ill trauma patients in the USA, 12,17 especially with regard to severe injuries to vital organs (eg cardiovascular, 18 brain 19 ). This phenomenon has been related directly to the experience gained by such centres due to the higher volume of patients they receive, 6,16,18,20 a fact that has led to reductions in mortality of as much as 50%.…”

Section: Discussionmentioning

confidence: 99%

Major cardiothoracic trauma: Eleven-year review of outcomes in the North West of England

Khorsandi

Skouras

Prasad

2015

annals

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INTRODUCTION Up to 15% of patients with cardiothoracic trauma require emergency surgery, and death can be prevented in a substantial proportion of this group. UK reports have emphasised the need for improvement in this field. We assessed major cardiothoracic trauma (MCT) outcomes in North West England over 11 years. METHODS The database from the Trauma Audit and Research Network was used to retrieve data for all patients who had suffered MCT between 2000 and 2011 in North West England and the findings analysed. Trauma that led to thoracotomy/thoracoscopy or sternotomy was defined as MCT. RESULTS A total of 146 patients were identified, and a considerable male predominance (88.4%) noted. A total of 54.1% had sustained penetrating cardiothoracic trauma. Also, 53.4% had been admitted to tertiary-care hospitals for trauma (TCHT) and 46.6% had been admitted to non-TCHT. Overall prevalence of mortality was 35.6%. No significant difference was found in mortality between TCHT vs non-TCHT. Prevalence of mortality was significantly higher in the subgroup of patients cared for exclusively in non-TCHT compared with patients transferred from non-TCHT to TCHT (41% vs 13.8%, p<0.05). CONCLUSION No significant difference was demonstrated in length of stay in hospital/length of stay in the intensive treatment unit and prevalence of mortality between patients originally presenting in TCHT and those presenting in non-TCHT. However, patients transferred from non-TCHT to TCHT had a lower prevalence of mortality. These findings may constitute a valuable benchmark for comparison with results arising after introduction of trauma centres in the UK.

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“…Centralising patients to centres with high volumes of activity is associated with better outcome, both for TBI [4][5][6][7] and after neurosurgery [8]. For a Hub & Spoke ICU system to work well, patients who no longer require the specific skills of the specialist ICU need to be repatriated as soon as clinically feasible.…”

Section: Discussionmentioning

confidence: 99%

“…The Hub ICU treats major trauma and neurosurgical patients, who are centralised to the Hub ICU. Centralising selected patients allows increased volume of activity for specific conditions, and improves patient outcomes [3][4][5][6][7][8]. Spoke ICUs admit patients with less severe disease, patients not expected to benefit from care in specialist ICUs, and patients discharged from the Hub ICU.…”

Section: Introductionmentioning

confidence: 99%

Satisfaction of patients’ next of kin in a ‘Hub & Spoke’ ICU network

et al. 2014

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SummaryThis study aimed to gauge the opinions of patients' next of kin regarding transfer of patients from the specialist ‘Hub’ intensive care unit, to ‘Spoke’ intensive care units near home. We included 213 consecutive patients with severe trauma or severe acute neurological conditions admitted to the Hub intensive care unit over a 21‐month period, who were repatriated to Spoke intensive care units for ongoing intensive care. One year after admission to the Hub intensive care unit, two thirds of patients' next of kin said they would have preferred patients to have been treated only in the Hub intensive care unit, and not repatriated. They perceived Hub intensive care unit care to be important, and would have preferred that their relatives be hospitalised there until intensive treatment was completed. The next of kin's preference was associated with severe acute neurological conditions (p ≤ 0.0001). Although centralised Hub & Spoke intensive care unit networks are appropriate to ensure specialised care, repatriation to local hospitals may not be appropriate for patients with severe neurological conditions.

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Effect of Trauma Center Designation on Outcome in Patients With Severe Traumatic Brain Injury

Cited by 93 publications

References 22 publications

Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study

Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study

Major cardiothoracic trauma: Eleven-year review of outcomes in the North West of England

Satisfaction of patients’ next of kin in a ‘Hub & Spoke’ ICU network

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