Improved trauma care in a rural hospital after establishing a level II trauma center

Wenneker, Wendell W.; Murray, Dwight H.; Ledwich, Thomas

doi:10.1016/s0002-9610(05)80768-8

Cited by 31 publications

(9 citation statements)

References 9 publications

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“…[32][33][34] In a national survey, nine tenths of institutions had such a team, at an annual cost generally Ͻ$5,000. 12 Nearly 70% of institutions in our study had a stroke team available by pager, and patients treated at these institutions tended to have a lower risk of in-hospital death in our study, but the association did not reach significance.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Gillum

2001

Stroke

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Background and Purpose-Data supporting the efficacy of stroke center characteristics are limited. Methods-A questionnaire detailing stroke treatment practices was sent to 42 academic medical centers in the University Health Systems Consortium. In-hospital mortality of all emergency department admissions for ischemic stroke at these institutions was evaluated in a database of discharge abstracts during 1997-1999. Institutional characteristics were evaluated as predictors of in-hospital mortality after adjustment for age, sex, race, hospital treatment volume of ischemic stroke, and admission status (emergent, urgent, elective). Length of stay (LOS), total hospital charges, and frequency of tissue plasminogen activator (tPA) administration were evaluated as secondary outcomes. We used a multivariable method called generalized estimating equations, which broadens confidence intervals to adjust for clustering of variables at institutions. Results-Thirty-two institutions completed the questionnaire, and 29 of these were included in the database of discharge abstracts. In-hospital deaths occurred in 758 (7.0%) of the 10 880 ischemic stroke patients admitted through the emergency department. In-hospital deaths were less frequent at hospitals with a vascular neurologist (odds ratio

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Section: Discussionmentioning

confidence: 99%

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Gillum

2001

Stroke

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“…53 Numerous studies of transportation practices of trauma patients have been conducted in rural settings, and all have shown that rapid access to EMS is both possible and beneficial. 54,55 Although we appreciate that the use of EMS for the rapid transportation of patients with acute stroke in a rural setting may present some logistical challenges, the experience with trauma patients suggests that these obstacles can be overcome. A recent study showed using a "pay-forperformance" system could improve EMS responses to several medical emergencies, including stroke.…”

Section: Emergency Medical Servicesmentioning

confidence: 99%

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

Alberts

Latchaw

Jagoda

et al. 2011

Stroke

195

167

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for the Brain Attack CoalitionBackground and Purpose-The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. Methods-We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Results-Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Conclusions-Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center. (Stroke. 2011;42:2651-2665.)

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“…Centralized trauma care has reduced the incidence of preventable death after injury dramatically [1][2][3][4][5][6][7][8]. Improvement in computed tomography (CT) technology has led to the introduction of multislice CT in early trauma diagnostics [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%