TY - JOUR
T1 - Do trauma centers improve outcome over non-trauma centers
T2 - The evaluation of regional trauma care using discharge abstract data and patient management categories
AU - Smith, J. Stanley
AU - Martin, Louis F.
AU - Young, Wanda W.
AU - Macioce, Darren P.
PY - 1990/12
Y1 - 1990/12
N2 - Development of regional medical care systems to treat patients who sustain major accidental injuries (trauma victims) has been based on autopsy studies which demonstrate that hospitals that meet certain accepted criteria of readiness (trauma centers) can prevent needless deaths of trauma victims. However, since only autopsy data have been available from non-trauma centers, it has not previously been possible to compare morbidity data between trauma centers and non-trauma hospitals. This study examines discharge abstract data and a new patient classification system called patient management categories (PMC) which are generated from this abstract data to evaluate length of stay (LOS), complications, and death to compare morbidity and mortality data from trauma centers and non-trauma centers. Discharge abstracts for 1,332 patients with the PMC of femoral shaft fracture with operation were obtained from all hospitals in Western Pennsylvania and Maryland for 1 year. Data from trauma centers were identified and compared to non-trauma centers using the following criteria: time to OR (=£2 days vs. >2 days), age (0-12, 13-55, >55 years), associated injuries, and development of complications and death. Patients treated in trauma centers had significantly fewer complications (21% vs. 33%; p < 0.001) and lower mortality rates (p < 0.05) than those treated in non-trauma centers. Associated injuries, age, complications, and/or delay in time to OR significantly increased intensity and length of stay in both trauma and non-trauma centers. This significantly increased the cost of care provided to these patients in both types of centers. In conclusion, examination of discharge abstract data using PMCs from large databases demonstrates that trauma center care both lowers mortality and significantly decreases morbidity rates for patients who have suffered major accidental injuries.
AB - Development of regional medical care systems to treat patients who sustain major accidental injuries (trauma victims) has been based on autopsy studies which demonstrate that hospitals that meet certain accepted criteria of readiness (trauma centers) can prevent needless deaths of trauma victims. However, since only autopsy data have been available from non-trauma centers, it has not previously been possible to compare morbidity data between trauma centers and non-trauma hospitals. This study examines discharge abstract data and a new patient classification system called patient management categories (PMC) which are generated from this abstract data to evaluate length of stay (LOS), complications, and death to compare morbidity and mortality data from trauma centers and non-trauma centers. Discharge abstracts for 1,332 patients with the PMC of femoral shaft fracture with operation were obtained from all hospitals in Western Pennsylvania and Maryland for 1 year. Data from trauma centers were identified and compared to non-trauma centers using the following criteria: time to OR (=£2 days vs. >2 days), age (0-12, 13-55, >55 years), associated injuries, and development of complications and death. Patients treated in trauma centers had significantly fewer complications (21% vs. 33%; p < 0.001) and lower mortality rates (p < 0.05) than those treated in non-trauma centers. Associated injuries, age, complications, and/or delay in time to OR significantly increased intensity and length of stay in both trauma and non-trauma centers. This significantly increased the cost of care provided to these patients in both types of centers. In conclusion, examination of discharge abstract data using PMCs from large databases demonstrates that trauma center care both lowers mortality and significantly decreases morbidity rates for patients who have suffered major accidental injuries.
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U2 - 10.1097/00005373-199012000-00017
DO - 10.1097/00005373-199012000-00017
M3 - Article
C2 - 2258968
AN - SCOPUS:0025686912
SN - 0022-5282
VL - 30
SP - 1533
EP - 1538
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 12
ER -