![]() The degree of functional disability among survivors at discharge was assessed using the functional independence measure (FIM) score. Outcomes (mortality, intensive care unit stay, and severe disability at discharge) were compared among level I and II trauma centers and among centers within the same level designation but different volumes of severe trauma (15 per year). The following data were included in a computerized spreadsheet and analyzed using SPSS 12.0 Windows (SPSS Inc, Chicago, Illinois) for the purpose of the study: age gender mechanism of injury (blunt or penetrating) hypotension on admission (systolic blood pressure ≤90 mm Hg or >90 mm Hg) abbreviated injury score (AIS) for head, chest, abdomen, and extremities injury severity score (ISS) severe liver trauma (International Classification of Diseases, 9th Revision codes 864.04, 864.09, 864.14, 864.19) penetrating cardiac injuries (861.03, 861.12) aortic injuries (901.0, 902.0) vena cava injuries (901.2, 902.0) iliac vascular injuries (902.53, 902.54, 902.50) quadriplegia (806.01, 806.06, 806.11, 806.16) and complex pelvic fractures (808.43, 808.53). The study included trauma patients older than 14 years of age who were alive on admission to the hospital and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, grade IV/V liver injuries, penetrating cardiac injuries, quadriplegia, or complex pelvic fractures ( Table 1) during the period 1996 through 2003. The number of admissions of patients with an ISS greater than 15 per year was also collected for each participating center. The ACS trauma level designation for each facility was categorized as level I, level II, or other. In addition to the patient-specific data, information for each admission was collected regarding the treating hospital. The database contains information on patient demographics, prehospital care, diagnoses and injury severity scoring, inpatient care and complications, as well as outcomes. This ongoing project represents the largest trauma registry ever assembled and currently contains over one million prospectively collected patient records. Overall, level I centers had significantly lower mortality (25.3% vs 29.3% adjusted odds ratio, 0.81 95% confidence interval, 0.71–0.94 P = 0.004) and significantly lower severe disability at discharge (20.3% vs 33.8%, adjusted OR, 0.55 95% CI, 0.44–0.69 P 15 (<240 vs ≥240 cases per year) had no effect on outcome in either level I or II centers.ĭata for this study was obtained from the National Trauma Data Bank (NTDB), which is maintained by the American College of Surgeons. Level III and IV trauma centers generally provide initial stabilization of trauma patients with the greatest difference being surgical capabilities at the Level III facilities.A total of 12,254 patients met the inclusion criteria. Level Is require some additional pediatric specialties and are research and teaching facilities. Level I and II Pediatric Trauma Centers focus specifically on pediatric trauma patients. Level I and II Trauma Centers have similar personnel, services, and resource requirements with the greatest difference being that Level Is are research and teaching facilities. It is recommended that readers consult the specific requirements for each Trauma Center designation level included in Title 22, Division 9, Chapter 7 – Trauma Care Systems which can be accessed at: regs7.pdf TRAUMA CENTER LEVELS It is intended only as a basic overview and is not inclusive of all requirements. The Trauma Center level information below is provided as a quick reference. Trauma Center designations include levels I – IV and Level I and II Pediatric (pediatric specific facilities). Performance Improvement and Patient Safety Program.A trauma program medical director and a trauma nurse coordinator.General requirements for all trauma centers include: All trauma centers are licensed hospitals, designated by a local Emergency Medical Services Agency (LEMSA) as a Trauma Center, and include personnel, services, and equipment necessary for the care of trauma patients.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |