Risk of Death among Cases Attending South Australian Major Trauma Services after Severe Trauma: The First 4 Years of Operation of a State Trauma System

Brennan, Peter W.; Everest, Evan; Griggs, William M; Slater, Anthony; Carter, Libby; Lee, Christine; Semmens, Julie K.; Wood, Debra J.; Nguyen, Anh Minh T; Owen, Dorothy L.; Pilkington, Prudence; Roder, David; Somers, Ronald L.

doi:10.1097/00005373-200208000-00024

Cited by 50 publications

(36 citation statements)

References 8 publications

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“…Our study suggests that for patients requiring emergency trauma surgery, major complica- tions and mortality are not associated with whether patients presented during the night or day, on a weekend versus a weekday, month of presentation, or year of presentation. In our analysis, sex was not a significant predictor of outcome following trauma care and this is consistent with other studies (West et al 2000, Brennan et al 2002, Croce et al 2002, Rappold et al 2002. The narrow confidence intervals surrounding many of our odds ratios provide greater confidence in these estimates of effect.…”

Section: Discussionsupporting

confidence: 90%

“…The risk of major complications rose with procedures involving the respiratory system. As with previous analyses of trauma registries, we found that older age and higher severity of injury were predictive of increased major complications and mortality following trauma care (Brennan et al 2002). Our study suggests that for patients requiring emergency trauma surgery, major complica- tions and mortality are not associated with whether patients presented during the night or day, on a weekend versus a weekday, month of presentation, or year of presentation.…”

Section: Discussionsupporting

confidence: 86%

“…The clinical usefulness of the ISS has been criticized (Rutledge 1996, Stephenson et al 2002 and alternate systems for characterizing traumatic injury have been developed in an attempt to improve quantification of injury severity (Merideth et al 2002). Due to the limitations of our data, we were unable to account for the impact of comorbidity, which has been shown to increase risk of mortality among trauma patients (Sacco et al 1993, Brennan et al 2002. Additionally, our study was restricted to the hospital phase of care and does not address pre-hospital access issues, the adequacy of emergency medical servicesʼ triage and transport, and post-hospital health status.…”

Section: Discussionmentioning

confidence: 99%

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The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery

Busse

Bhandari

Devereaux

2004

Acta Orthopaedica Scandinavica

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BackgroundPrevious studies have shown a relationship between time of admission to hospital and mortality rates; however, it is uncertain whether such a relationship exists for patients requiring emergency trauma surgery.Methods We included all trauma patients, except those with moderate to severe burns, who presented to a university-affiliated level 1 trauma center and underwent surgery, from 1995 until 2001 (n = 1044). We conducted univariate and multivariate analyses in which the dependent variables were in-hospital mortality and major complications, and the independent variables were the time of presentation to the trauma centre (nighttime vs. daytime, weekend vs. weekday, month of year, and year), age, sex, injury severity score, type of operative procedure, and total number of operative procedures.Results None of the factors related to time of presentation were associated with major complications or mortality. Factors predictive of increased mortality were higher ISS (odds ratio 1.07; 95% confidence interval 1.03-1.08), older age (1.04; 1.03-1.07), operations involving the cardiovascular system (1.7; 1-2.6), "miscellaneous" operative procedures (1.8; 1.1-2.9), and major complications (2.4; 1.4-4.2).Interpretation Time of presentation for emergency trauma surgery was not associated with differences in major complications or in mortality.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery

Busse

Bhandari

Devereaux

2004

Acta Orthopaedica Scandinavica

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“…A number of studies have reported the inability to collect the values necessary for the RTS in all cases with missing data ranging from 3% to 28%, [4][5][6][7][8][9][10][11] leading to a variety of mostly unvalidated methods to compensate for the loss of information, or case exclusion. These practical limitations result in a situation in which the TRISS cannot be calculated for a subset of patients (usually the most severely injured), reducing its usefulness as a standard component of trauma registries and surveillance systems.…”

Section: Components Of Trissmentioning

confidence: 99%

TRISS: Does It Get Better than This?

Gabbe

Cameron

Wolfe

2004

Academic Emergency Medicine

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The Trauma and Injury Severity Scoring (TRISS) system was developed in the 1980s to improve the prediction of patient outcomes following trauma through the use of physiological and anatomical criteria. The TRISS is used for a number of purposes, including quantifying the severity of injury of a patient population, calculating the probability of survival of patients for identification of cases for peer review, and comparing the death or survival rates of different populations/hospitals. Despite the advancements in trauma care, improved statistical techniques, and the identification of numerous limitations of TRISS, it continues to be the most commonly used tool for judging hospital performance and monitoring trauma death rates. This article critically evaluates the development, structure, and practical use of TRISS to determine its value in the current trauma environment. Limitations of TRISS are discussed and suggestions are made for the future development of trauma prediction tools.

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“…20-30 % of severe trauma cases present initially to a health care facility that is not a trauma center [10,11]. Australia has a taxpayer-funded free health care scheme (Medicare) [12].…”

Section: Current Practical Aspects In Different Trauma Systemsmentioning

confidence: 99%

Trauma systems: models of prehospital and inhospital care

Hofman¹,

Sellei²,

Peralta

et al. 2012

Eur J Trauma Emerg Surg

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This manuscript deals with the differences of several trauma systems in certain European countries, the USA and Australia. It aims to provide an overview of the peculiarities and influences of these systems on the clinical management. However, the effect of differences in organization in different countries on patient outcome is difficult to assess. There appears to be consensus on the fact that structured treatment for acute trauma care is beneficial for trauma patients. Thus, any kind of organization contributes to improved patient outcome.

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Risk of Death among Cases Attending South Australian Major Trauma Services after Severe Trauma: The First 4 Years of Operation of a State Trauma System

Abstract: Results show a decrease in risk of death of patients attending South Australian major trauma services, from injuries of equivalent severity, during the first 4 years of operation of the State Trauma System.

Cited by 50 publications

References 8 publications

The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery

The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery

TRISS: Does It Get Better than This?

Trauma systems: models of prehospital and inhospital care

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