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Senior Citizen Health & Medicine
Being Taken to Level 1 Trauma Center May Not Be As
Desirable as It Sounds
New study finds the results being produced by these
premier hospitals inconsistent
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Percent who think it is important
to go to trauma center when severely injured |
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Feb. 18, 2008 - A survey in 2005 found nine out of
ten Americans think it is really important to be taken to a trauma
center in the event of a life-threatening injury. But, most Americans
probably do not really know what a trauma center is, nor what they do.
Even most disturbing, a new study finds widely varying results are being
produced in the countrys few Level 1 Trauma Centers.
A report in the February issue of Archives of
Surgery, one of the JAMA/Archives journals says trauma centers
designated as level I may have significantly different results when
treating patients with similar injuries.
"Decades of concerted efforts by trauma
professionals and patient advocacy groups have led to the development of
trauma centers in most states," the authors write.
"A critical component of these systems is the use
of explicit criteria for the availability of personnel, equipment and
services through the process of trauma center verification by the
American College of Surgeons (ACS)."
These criteria are based on structures and
processes deemed essential for providing the best care.
Shahid Shafi, M.D., M.P.H., and colleagues at the
University of Texas Southwestern Medical School, Dallas, analyzed data
from 211,479 patients admitted to 47 level I trauma centers between 1999
and 2003.
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About Trauma
Centers |
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Trauma centers
are selected hospitals that provide a full range of care for
severely injured patients 24 hours a day, seven days a week.
This trauma care includes ready-to-go-teams that perform
immediate surgery and other necessary procedures for people with
serious or life-threatening injuries, for example, due to a car
accident, burn, bad fall, or gunshot. |
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From Wikipedia |
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In the
United States, a Level I trauma center provides the highest
level of surgical care to
trauma patients.
A Level I
trauma center is required to have a certain number of
surgeons and
anesthesiologists on duty 24 hours a day at the hospital, an
education program, preventive and outreach programs. Key
elements include 24-hour in-house coverage by general surgeons
and prompt availability of care in varying specialties such as
orthopedic surgery,
neurosurgery,
anesthesiology,
emergency medicine,
radiology,
internal medicine, oral and maxillofacial surgery, and
critical care, which are needed to adequately respond and care
for various forms of trauma that a patient may suffer.
Level I trauma-center hospitals in most states in
the U.S. (New
York,
Pennsylvania and
Florida among others are notable exceptions) are designated
by the
American College of Surgeons (ACS) for a period of three
years. Pennsylvania has its own rankings system, based on the
criteria of the Commonwealth's Trauma Foundation.
The ACS does not officially designate hospitals
as regional trauma centers, however. Numerous U.S. hospitals
that are not listed on the organization's trauma roster
nevertheless refer to their emergency or trauma units as "Level
I trauma centers."
The ACS describes that responsibility as a
geopolitical process by which empowered entities, government or
otherwise, are authorized to designate. The ACSs
self-appointed mission is limited to confirming and reporting on
any given hospitals ability to comply with the ACS standard of
care known as Resources for Optimal Care of the Injured Patient.
Lower levels of trauma care are provided by
Level II trauma centers
Level III trauma centers
Level IV trauma centers
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The patients were divided into three groups based
on the severity of their injuries, assessed by a number of measures such
as blood pressure and the presence or absence of shock.
The average percentage of patients who survived was
calculated for all trauma centers; survival rates from individual
centers were then compared to this average.
The average survival rate was 99 percent for
patients with mild injuries, 75 percent for those with moderate injuries
and 35 percent for those with severe injuries.
"For mild injuries, survival at five centers (11%
of the centers) was significantly worse than that at their counterpart
centers," the authors write.
"With increasing injury severity, the percentages
of outcome disparities increased (15% of centers for moderate injuries
and 21% of centers for severe injuries) and persisted in subgroups of
patients with head injuries, patients sustaining penetrating injuries
and older (more than 55 years) individuals."
"These variations in outcomes may represent a
substantial quality chasm in the delivery of trauma care," they added.
It is possible that the verification process may
not specify all resources needed to provide optimal care, the authors
note.
For example, one previous study showed that the
presence of a trauma and surgical critical care fellowship program
improved outcomes at level I trauma centers, though it is not a
criterion required for verification.
In addition, having all the necessary resources
does not ensure they will be deployed adequately.
"If confirmed, our preliminary data suggest that
the logical next step for the trauma community is to move beyond
focusing on personnel and processes and to start focusing on the
outcomes achieved by the use of those resources," the authors conclude.
About American
College of Surgeons and Trauma Centers
List of Trauma Centers in U.S.
Through its
Committee on Trauma, ACS works to improve the care of injured and
critically ill patients--before, en route to, and during
hospitalization. Conducts training courses in emergency care for
ambulance personnel; sponsors courses for the management and prevention
of injuries for trauma specialists as well as for physicians who do not
treat trauma victims on a regular basis; and works to encourage
hospitals to upgrade their trauma care capabilities. Maintains a
voluntary verification/consultation program for trauma centers.
College Supports
Legislation to Provide Federal Funding for Trauma Centers
The American
College of Surgeons recently sent a letter of support to Sens. Patty
Murray (D-WA), Johnny Isakson (R-GA), Jeff Bingaman (D-NM), and Kay
Bailey Hutchison (R-TX) for their sponsorship of S. 2319, the National
Trauma Stabilization Act. Introduced in November 2007, the bill would
provide critical funding to trauma centers that are at risk of closure
due to continual increases in costs for uncompensated and charity care.
Spearheaded by the National Foundation for Trauma Care, the bill
contains language drawn from the original trauma systems law, Title XII
of the Public Health Service Act, which passed in 1990. Essentially, S.
2319 would reauthorize and expand Part D of Title XII, which pertains to
trauma centers in areas severely affected by drug-related violence. The
National Trauma Stabilization Act broadens the scope of this provision
to include all trauma centers and stipulates that they follow ACS trauma
registry guidelines and participate in trauma systems to qualify for
federal funding.
Harris Interactive
Survey in 2005 for ACS
>> After hearing a
description of a trauma center, Americans value them highly and
appreciate the importance of having one within easy reach.
● Almost all
Americans feel it is extremely or very important to be treated at a
trauma center in the event of a life-threatening injury.
● Nearly nine
in ten Americans think it is extremely or very important for an
ambulance to take them to a trauma center in the event of a
life-threatening injury, even if it is not the closest hospital.
● Nearly all
Americans believe that if they had a serious or life-threatening injury,
they would be taken to the hospital that is best equipped to handle
their specific injury in less than 1 hour.
>> Majorities of
Americans feel that having a trauma center nearby is as important as or
more important than having a Fire Department or Police Department.
More about trauma centers
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