Inclusive Trauma Systems: Do They Improve Triage or Outcomes of the Severely Injured?

Utter, Garth H.; Maier, Ronald V.; Rivara, Frederick P.; Mock, Charles N.; Jurkovich, Gregory J.; Nathens, Avery B.

doi:10.1097/01.ta.0000204022.36214.9e

Cited by 152 publications

(100 citation statements)

References 20 publications

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“…1 In the past 4 decades, regionalized trauma care has been promoted in the U.S. as the best approach for matching patient needs with the available resources and provider expertise to achieve optimal patient outcomes. [2][3][4][5] Previous research has shown that trauma centers achieve better outcomes among severely injured patients than non-trauma centers; however, it has been found that about one-third of patients with severe injuries were treated at nontrauma centers or level III trauma centers. 3,6 Transportation to the hospital via Emergency Medical Service (EMS) is important in caring for trauma patients for several reasons.…”

Section: Introductionmentioning

confidence: 99%

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Corrado

Shi

Wheeler

et al. 2017

The American Journal of Emergency Medicine

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Objectives-This study aimed to assess the proportions of injured children transported to trauma centers by different transportation modes and evaluate the effect of transportation mode on interfacility transfer rates using the U.S. national trauma registry.Methods-We analyzed data from the 2007-2012 National Trauma Data Bank (NTDB) to study trends of EMS versus non-EMS transport. Multivariable logistic regression was used to evaluate the association between transport mode and inter-facility transfer.Results-There were 286,871 pediatric trauma patients in the 2007-2012 NTDB; 45.8% arrived by ground ambulance, 8.6% arrived by air ambulance, and 37.5% arrived by non-EMS. From 2007-2012, there was no significant change among each transportation mode. Moderate to severely injured patients (ISS>15) comprised 13.3% of arrivals by ground ambulance, 26.7% of arrivals by air ambulance, and 8.3% of arrivals by non-EMS; those who used EMS were significantly less likely to be transferred to another facility than patients who used non-EMS transport. Moderate and severe pediatric patients arriving by non-EMS to adult trauma centers were more often transferred than those arriving at mixed trauma centers (45.8% and 6.8%, respectively).Conclusions-Over one third of US pediatric trauma patients used non-EMS transport to arrive at trauma centers. Moderate to severely injured children benefit from EMS transport and

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Section: Introductionmentioning

confidence: 99%

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Corrado

Shi

Wheeler

et al. 2017

The American Journal of Emergency Medicine

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“…25 However, the use of more inclusive trauma systems appears to mitigate these effects. 26 This mitigation is probably the result of having lower-level centers ready to resuscitate patients and initiate treatment of major injuries, as well as broad acceptance of systemwide protocols that expedite transfer when appropriate.…”

Section: Costs and Benefits Of Trauma Systemsmentioning

confidence: 99%

Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To Patient Health Care Needs

2013

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Trauma systems provide an organized approach to the care of injured patients within a defined geographic region. When fully operational, the systems ensure a continuum of care involving public access through 911 calls, emergency medical services, timely triage and transport to acute care, and transfer to rehabilitation services. Substantial progress has been made in establishing statewide trauma systems, which are seen as the prototype for regionalized care for other time-sensitive, emergency conditions such as stroke. Trauma systems provide a model of care that is consistent with the goals of the Affordable Care Act, which authorizes $100 million in annual grants to ensure the continued availability of trauma services. Full funding of these provisions is needed to stabilize statewide systems that are struggling to survive. We describe the components of a regionalized trauma system, review the evidence in support of this approach, and discuss the challenges to sustaining systems that are accountable and affordable.

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“…[5][6][7][8] Studies of trauma system effectiveness have reported improved patient survival, particularly among seriously injured patients, and reduced time to definitive institutional trauma care. 2,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] The importance of trauma systems concepts and the key role they play in obviating the enormous burden of injury in society has been demonstrated in numerous studies, reviews and editorials but is rarely a studied health care issue in Canada. 13,[20][21][22][23][24][25][26] Between 1995 and 1998, the province of Nova Scotia, Canada, underwent a government-mandated transition from a province without a trauma system to one incorporating most of the components of a modern trauma and emergency medical service (EMS) system.…”

Section: Discussionmentioning

confidence: 99%

Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation

et al. 2012

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Background: Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation.

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Inclusive Trauma Systems: Do They Improve Triage or Outcomes of the Severely Injured?

Cited by 152 publications

References 20 publications

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To Patient Health Care Needs

Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation

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