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Trauma Systems

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Severe traumatic brain injuries in children: Does the type of trauma center matter?
Bardes JM, Benjamin E, Escalante AA, Wu J, Demetriades D.
J Pediatr Surg. 2018 Aug;53(8):1523-1525.

Rationale for inclusion: The NTDB from 2007-2014 was used to assess mortality in isolated pediatric TBI patients.  Overall, pediatric TBI patients had improved mortality at PTC when compared to ATC though there was no difference when comparing PTC to MTC.  In subgroup analysis of AIS 3 vs AIS 4 vs AIS 5, there was no difference in mortality between centers for AIS 3 and 5, but MTC had improved mortality with AIS 4 ptients.

CAVEAT: There have been a lot of changes in pediatric trauma centers over the study period.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Impact of Volume Change Over Time on Trauma Mortality in the United States.
Brown JB, Rosengart MR, Kahn JM, Mohan D, Zuckerbraun BS, Billiar TR, Peitzman AB, Angus DC, Sperry JL.
Ann Surg. 2017 Jul;266(1):173-178.

Rationale for inclusion: NTDB study of severely injured patients (ISS>15) determined that each 1% increase in volume was associated with a 73% increased odd of improvement in a center-level standardized mortality ratio at level I and II centers.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Big children or little adults? A statewide analysis of adolescent isolated severe traumatic brain injury outcomes at pediatric versus adult trauma centers.
Gross BW, Edavettal MM, Cook AD, Rinehart CD, Lynch CA, Bradburn EH, Wu D, Rogers FB.
J Trauma Acute Care Surg. 2017 Feb;82(2):368-373.

Rationale for inclusion: The Pennsylvania trauma outcome study database was used to examine outcomes for adolescents (ages 15-17) with isolated severe traumatic brain injury (AIS>3).  In an adjusted analysis accounting for severity of injury and facility, no differences were  found in mortality or complications.

CAVEAT: Single state study. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Pediatric and adult trauma centers differ in evaluation, treatment, and outcomes for severely injured adolescents.
Walther AE, Falcone RA, Pritts TA, Hanseman DJ, Robinson BR.
J Pediatr Surg. 2016 Aug;51(8):1346-50.

Rationale for inclusion: The NTDB from 2007-2011 was queried to determine if outcomes differed for adolescents with severe trauma treated at pediatric versus adult trauma centers.  Severity of injury was similar between centers based on ISS and mortality.  ATC performed more imaging and invasive procedures while PTC had shorter LOS and more home discharges.

CAVEAT: There have been a lot of changes in pediatric trauma centers over the study period.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Development and Validation of the Air Medical Prehospital Triage Score for Helicopter Transport of Trauma Patients.
Brown JB, Gestring ML, Guyette FX, Rosengart MR, Stassen NA, Forsythe RM, Billiar TR, Peitzman AB, Sperry JL.
Ann Surg. 2016 Aug;264(2):378-85.

Rationale for inclusion: NTDB study used to develop an Air Medical Prehospital Triage score with an optimal cutpoint for HEMS transport of ≥2.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Association Between Trauma Center Type and Mortality Among Injured Adolescent Patients.
Webman RB, Carter EA, Mittal S, Wang J, Sathya C, Nathens AB, Nance ML, Madigan D, Burd RS
JAMA Pediatr. 2016 Aug 1;170(8):780-6

Rationale for inclusion: The NTDB from 2010 was used to compare mortality between adolescents (ages 15-19) treated at ATC versus MTC versus PTC.  Most patients were treated at ATC (69%) or MTC (26%) with only 6% at PTC.  After controlling for sex, mechanims of injury, severity of injury, and clinical status (blood pressure and GCS), adoelscents had lower mortality when treated at PTC.  THere was no difference seen between level I and II trauma centers.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Mortality Among Injured Children Treated at Different Trauma Center Types.
Sathya C, Alali AS, Wales PW, Scales DC, Karanicolas PJ, Burd RS, Nance ML, Xiong W, Nathens AB.
JAMA Surg. 2015 Sep;150(9):874-81.

Rationale for inclusion: Using data from TQIP, the authors demonstrate an association between improved pediatric trauma mortality and receiving care at a pediatric trauma center, rather than at an adult trauma center or a mixed trauma center. This association was particularly true in the youngest children and in the most severely injured children.  This suggests opportunities for quality improvement at all centers where children receive injury care. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system.
Gabbe BJ, Simpson PM, Sutherland AM, Wolfe R, Fitzgerald MC, Judson R, Cameron PA.
Ann Surg. 2012 Jun;255(6):1009-15.

Rationale for inclusion: Major trauma survivors had better functional outcomes if managed at Level 1 Trauma Centers.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury.
Brown JB, Stassen NA, Bankey PE, Sangosanya AT, Cheng JD, Gestring ML.
J Trauma. 2010 Nov;69(5):1030-4; discussion 1034-6.

Rationale for inclusion: Helicopter transport was associated with improved survival despite higher severity injuries and longer transport times.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997-2008.
Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM.
J Trauma. 2010 Sep;69(3):620-6.

Rationale for inclusion: Improvements in trauma care over a 12-year period in one trauma center kept pace with increasing age and injury severity as measured by mortality.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Epidemiology of traumatic deaths: comprehensive population-based assessment.
Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ.
World J Surg. 2010 Jan;34(1):158-63.

Rationale for inclusion: Epidemiology of deaths after trauma now show a skew towards early deaths when compared to trimodal distribution of death found in earlier, American studies.  This contemporary study shows that low level falls now cause 41% of mortalities in Australia.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?
Pracht EE, Tepas JJ 3, Langland-Orban B, Simpson L, Pieper P, Flint LM.
J Pediatr Surg. 2008 Jan;43(1):212-21

Rationale for inclusion: Relatively recent paper looking at a statewide registry with a large number of patients.  Found that designated adult centers performed better than non-trauma centers.  However, designated pediatric trauma centers performed better than adult trauma centers.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Incidence and lifetime costs of injuries in the United States.
Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E.
Inj Prev. 2006 Aug;12(4):212-8.

Rationale for inclusion: Economic analysis demonstrating the large burden of injury in the United States.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

A national evaluation of the effect of trauma-center care on mortality.
MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO.
N Engl J Med. 2006 Jan 26;354(4):366-78.

Rationale for inclusion: Multi-center analysis showing improved outcomes for patients treated at trauma centers when compared to non-trauma centers.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study.
Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE; Trauma Audit and Research Network.
Lancet. 2005 Oct 29-Nov 4;366(9496):1538-44.

Rationale for inclusion: Treatment of brain injury in a neurosurgical center in England and Wales led to improved outcomes.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

The effect of trauma center designation and trauma volume on outcome in specific severe injuries.
Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L.
Ann Surg. 2005 Oct;242(4):512-7; discussion 517-9.

Rationale for inclusion: Level 1 Trauma Centers have better outcomes than lower-level centers, not associated with volumes.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Access to trauma centers in the United States.
Branas CC, MacKenzie EJ, Williams JC, Schwab CW, Teter HM, Flanigan MC, Blatt AJ, ReVelle CS.
JAMA. 2005 Jun 1;293(21):2626-33.

Rationale for inclusion: Analysis of distribution of trauma centers to determine the percentage of the population living within 45 or 60 minutes of a trauma center.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Development of trauma systems and effect on outcomes after injury.
Nathens AB, Brunet FP, Maier RV.
Lancet. 2004 May 29;363(9423):1794-801.

Rationale for inclusion: Comparison of US vs France. In US, focus is on trauma center, and in France, focus is on prehospital care. Crude mortality rates are higher in France, although difficult to adjust for confounders.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry.
Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford SR, Badger GJ.
J Trauma. 2001 Jan;50(1):96-101.

Rationale for inclusion: In this look at variability between mortality rates in pediatric trauma patients between adult and pediatric trauma centers, more severely injured patients were being cared for in adult centers and mortality rate was not different when crrected for this.  Also showed a significant impact of ACS verification.

CAVEAT: This study is 15 years old, and the verification process has changed significantly.  The number of true pediatric trauma centers has grown significantly since this was published and more injured patients may now be preferentially directed to pediatric trauma centers.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Impact of pediatric trauma centers on mortality in a statewide system.
Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR.
J Trauma. 2000 Aug;49(2):237-45.

Rationale for inclusion: Early paper showing that adult trauma centers with added certification in pediatric trauma have better outcomes than adult trauma centers without this qualification. These differences were greatest with head, liver, and spleen injuries. 

CAVEAT: This study is 16 years old, and the verification process has changed significantly.  The defined trauma center designations no longer exist.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

The effect of organized systems of trauma care on motor vehicle crash mortality.
Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV.
JAMA. 2000 Apr 19;283(15):1990-4.

Rationale for inclusion: Organized trauma system improves mortality after MVC.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation.
Nathens AB, Jurkovich GJ, Rivara FP, Maier RV.
J Trauma. 2000 Jan;48(1):25-30; discussion 30-1.

Rationale for inclusion:  Analysis of states with trauma systems compared with states without trauma systems. A state trauma system is associated with a reduction in the risk of death caused by injury. The effect is most evident on analysis of MVC deaths.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Trauma care regionalization: a process-outcome evaluation.
Sampalis JS, Denis R, Lavoie A, Fr├ęchette P, Boukas S, Nikolis A, Benoit D, Fleiszer D, Brown R, Churchill-Smith M, Mulder D.
J Trauma. 1999 Apr;46(4):565-79; discussion 579-81.

Rationale for inclusion: Utilizing Quebec Trauma Registry; treatment of patients at a trauma center, reduced prehospital time, and treatment at a tertiary center contributed to decreased mortality.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Influence of a statewide trauma system on pediatric hospitalization and outcome.
Hulka F, Mullins RJ, Mann NC, Hedges JR, Rowland D, Worrall WH, Sandoval RD, Zechnich A, Trunkey DD.
J Trauma. 1997 Mar;42(3):514-9.

Rationale for inclusion: A dated study, but with an interesting conclusion that prevention efforts may have a much larger impact on pediatric trauma mortality the establishment of a trauma system.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Send severely head-injured children to a pediatric trauma center.
Johnson DL, Krishnamurthy S.
Pediatr Neurosurg. 1996 Dec;25(6):309-14.

Rationale for inclusion: One of the first papers to show that particularly in children with traumatic brain injury, delivery directly to a pediatric trauma center rather than first stopping at a non-trauma center has a positive survival effect.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

The outcome for children with blunt trauma is best at a pediatric trauma center.
Hall JR, Reyes HM, Meller JL, Loeff DS, Dembek R.
J Pediatr Surg. 1996 Jan;31(1):72-6; discussion 76-7.

Rationale for inclusion: Early paper to suggest that the difference in outcome between adult and pediatric trauma centers only applies to blunt trauma patients, with little difference with respect to penetrating trauma.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Epidemiology of trauma deaths: a reassessment.
Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, Pons PT.
J Trauma. 1995 Feb;38(2):185-93.

Rationale for inclusion: Analysis of epidemiology of trauma deaths in a trauma system (Denver), compared with historical epidemiology, showing improved access to the medical system and greater proportion of late deaths due to brain injury.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Outcome of hospitalized injured patients after institution of a trauma system in an urban area.
Mullins RJ, Veum-Stone J, Helfand M, Zimmer-Gembeck M, Hedges JR, Southard PA, Trunkey DD.
JAMA. 1994 Jun 22-29;271(24):1919-24.

Rationale for inclusion: Establishment of a trauma center in an urban area shifted sicker patients to the trauma center and improved outcomes.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report.
Shackford SR, Hollingworth-Fridlund P, Cooper GF, Eastman AB.
J Trauma. 1986 Sep;26(9):812-20.

Rationale for inclusion: Before and after study of trauma care after a trauma system was initiated with improvement in care.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Organization and function of a regional pediatric trauma center: does a system of management improve outcome?
Haller JA Jr, Shorter N, Miller D, Colombani P, Hall J, Buck J.
J Trauma. 1983 Aug;23(8):691-6.

Rationale for inclusion: One of the first papers to look at establishment of a trauma system and its beneficial effect on morbidity and mortality in pediatric trauma  patients.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Systems of trauma care. A study of two counties.
West JG, Trunkey DD, Lim RC.
Arch Surg. 1979 Apr;114(4):455-60.

Rationale for inclusion: Comparison of two counties; San Francisco county utilized one trauma hospital and Orange County utilized the closest hospital. Survival was improved in the county that utilized one trauma hospital.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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Eastern Association for the Surgery of Trauma

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