Effectiveness of regionalization of trauma care services: a systematic review

Vali, Yasaman; Rashidian, Arash; Jalili, Mohammad; Omidvari, Amir Houshang; Jeddian, Alireza

doi:10.1016/j.puhe.2016.12.006

Cited by 48 publications

(39 citation statements)

References 43 publications

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“…37 These findings for HNC patients along with similar findings for other procedures have increased interest in exploring the possibility of regionalizing the procedures to improve patient outcomes. 38,39 The Centers for Medicare and Medicaid Services has designated some hospitals as centers of excellence on the basis of data indicating improved outcomes. 40 Recent data indicate an increasing regionalization of HNC care to teaching and academic hospitals.…”

Section: Discussionmentioning

confidence: 99%

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

Gupta

Sonis

Schneider

et al. 2017

Cancer

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Uninsured patients or patients insured by government programs predominantly underwent care for HNC at hospital types most often associated with inferior survival outcomes. This finding could explain some proportion of insurance-related disparities in HNC outcomes. Further studies are warranted to determine whether interventions to promote equitable access to optimal hospital settings for patients, regardless of their insurance type, might improve outcomes among nonprivate insurance holders. Cancer 2018;124:760-8. © 2017 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

Gupta

Sonis

Schneider

et al. 2017

Cancer

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“…2 Preferentially triaging severely injured patients directly to specialized trauma centres (TCs) has been shown to reduce mortality. 3 Although regionalization of trauma care services reduces trauma-related mortality, 4 it has significant access implications because of the concentration of specialized resources in few discrete geographic locations. Distance to a TC correlates with time to definitive care, and there is evidence that shorter prehospital times are associated with increased survival.…”

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confidence: 99%

Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia

Tansley

Schuurman

Bowes

et al. 2019

cjs

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Background: Trauma is a leading contributor to the burden of disease in Canada, accounting for more than 15 000 deaths annually. Although caring for injured patients at designated trauma centres (TCs) is consistently associated with survival benefits, it is unclear how travel time to definitive care influences outcomes. Using a population-based sample of trauma patients, we studied the association between predicted travel time (PTT) to TCs and mortality for patients assigned to ground transport. Methods: Victims of penetrating trauma or motor vehicle collisions (MVCs) in Nova Scotia between 2005 and 2014 were identified from a provincial trauma registry. We conducted cost distance analyses to quantify PTT for each injury location to the nearest TC. Adjusted associations between TC access and injury-related mortality were then estimated using logistic regression. Results: Greater than 30 minutes of PTT to a TC was associated with a 66% increased risk of death for MVC victims (p = 0.045). This association was lost when scene deaths were excluded from the analysis. Sustaining a penetrating trauma greater than 30 minutes from a TC was associated with a 3.4-fold increase in risk of death. Following the exclusion of scene deaths, this association remained and approached significance (odds ratio 3.48, 95% confidence interval 0.98-14.5, p = 0.053). Conclusion: Predicted travel times greater than 30 minutes were associated with worse outcomes for victims of MVCs and penetrating injuries. Improving communication across the trauma system and reducing prehospital times may help optimize outcomes for rural trauma patients. Contexte : Les traumatismes contribuent pour une bonne part au fardeau de la maladie au Canada; on leur attribue plus de 15 000 décès annuellement. Même si les soins prodigués aux patients victimes de traumatismes dans les centres de traumatologie désignés (CTD) sont toujours associés à des gains au plan de la survie, on ignore quelle est l'influence du temps de transfert vers le CTD sur l'issue. À partir d'un échantillon de patients polytraumatisés basé dans la population, nous avons analysé le lien entre le temps de transfert prévu (TTP) vers le CTD et la mortalité des patients transportés par voie terrestre. Méthodes : On a identifié les victimes de traumatismes pénétrants ou d'accidents de la route en Nouvelle-Écosse entre 2005 et 2014 à partir d'un registre provincial de traumatologie. Nous avons analysé la distance de coût pour quantifier le TTP à partir de chaque scène vers le CTD le plus proche. Les liens ajustés entre l'accès au CTD et la mortalité liée au traumatisme ont ensuite été estimés par régression logistique. Résultats : Un délai de TTP de plus de 30 minutes pour arriver au CTD a été associé à un accroissement de 66 % du risque de décès chez les patients polytraumatisés (p = 0,045). Ce lien s'annulait si on excluait de l'analyse les décès survenus sur la scène de l'accident. Subir un traumatisme ouvert à plus de 30 minutes de distance d'un CTD a été associé à une augmentation par un facteu...

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“…Globally, trauma systems or designated trauma centers have been estimated to reduce the odds of mortality by 15% when compared to non-designated hospitals or health systems with no formal trauma system in North America [10]. Similarly, regionalized trauma systems have been associated with a 16% reduction in mortality odds compared to healthcare jurisdictions with no trauma system [59]. However, our results on trauma system maturity support the hypothesis that trauma systems are not fully effective until up to 10 years after their implementation [4,60] and suggest that these estimates of mortality reduction are probably underestimated.…”

Section: Discussionmentioning

confidence: 99%

Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta‐Analysis

Moore

Champion²,

Tardif

et al. 2017

World j. surg.

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Effectiveness of regionalization of trauma care services: a systematic review

Cited by 48 publications

References 43 publications

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia

Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta‐Analysis

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