Ernest E. Sullivent

Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.

BACKGROUND A decade after promulgation of treatment guidelines by the Brain Trauma Foundation (BTF), few studies exist that examine the application of these guidelines for severe traumatic brain injury (TBI) patients. These studies have reported both cost savings and reduced mortality. MATERIALS We projected the results of previous studies of BTF guideline adoption to estimate the impact of widespread adoption across the United States. We used surveillance systems and national surveys to estimate the number of severely injured TBI patients and compared the lifetime costs of BTF adoption to the current state of treatment. RESULTS After examining the health outcomes and costs, we estimated that a substantial savings in annual medical costs (

Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services

262 million), annual rehabilitation costs (

Large Cost Savings Realized from the 2006 Field Triage Guideline: Reduction in Overtriage in U.S. Trauma Centers

43 million) and lifetime societal costs (

Postexposure interventions to prevent infection with HBV, HCV, or HIV, and tetanus in people wounded during bombings and other mass casualty events-united states, 2008 recommendations of the centers for disease control and prevention and disaster medicine and public health preparedness

3.84 billion) would be achieved if treatment guidelines were used more routinely. Implementation costs were estimated to be

Managing traumatic brain injury secondary to explosions

61 million. The net savings were primarily because of better health outcomes and a decreased burden on lifetime social support systems. We also estimate that mortality would be reduced by 3,607 lives if the guidelines were followed. CONCLUSIONS Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

Blast injuries from bombings: what craniofacial and maxillofacial surgeons need to know

Abstract Background. Some studies have shown improved outcomes with helicopter emergency medical services (HEMS) transport, while others have not. Safety concerns and cost have prompted reevaluation of the widespread use of HEMS. Objective. To determine whether the mode of transport of trauma patients affects mortality. Methods. Data for 56,744 injured adults aged ≥18 years transported to 62 U.S. trauma centers by helicopter or ground ambulance were obtained from the National Sample Program of the 2007 National Trauma Data Bank. In-hospital mortality was calculated for different demographic and injury severity groups. Adjusted odds ratios (AOR) were produced by utilizing a logistic regression model measuring the association of mortality and type of transport, controlling for age, gender, and injury severity (Injury Severity Score [ISS] and Revised Trauma Score [RTS]). Results. The odds of death were 39% lower in those transported by HEMS compared with those transported by ground ambulance (AOR = 0.61, 95% confidence interval [CI] = 0.54–0.69). Among those aged ≥55 years, the odds of death were not significantly different (AOR = 0.92, 95% CI = 0.74–1.13). Among all transports, male patients had a higher odds of death (AOR = 1.23, 95% CI = 1.10–1.38) than female patients. The odds of death increased with each year of age (AOR = 1.040, 95% CI = 1.037–1.043) and each unit of ISS (AOR = 1.080, 95% CI = 1.075–1.084), and decreased with each unit of RTS (AOR = 0.46, 95% CI = 0.45–0.48). Conclusion. The use of HEMS for the transport of adult trauma patients was associated with reduced mortality for patients aged 18–54 years. In this study, HEMS did not improve mortality in adults aged ≥55 years. Identification of additional variables in the selection of those patients who will benefit from HEMS transport is expected to enhance this reduction in mortality.

Guidelines for field triage of injured patients. Recommendations of the national expert panel on field triage

Abstract Background. Ambulance transport of injured patients to the most appropriate medical care facility is an important decision. Trauma centers are designed and staffed to treat severely injured patients and are increasingly burdened by cases involving less-serious injury. Yet, a cost evaluation of the Field Triage national guideline has never been performed. Objectives. To examine the potential cost savings associated with overtriage for the 1999 and 2006 versions of the Field Triage Guideline. Methods. Data from the National Hospital Ambulatory Medical Care Survey and the National Trauma Databank (NTDB) produced estimates of injury-related ambulatory transports and exposure to the Field Triage guideline. Case costs were approximated using a cost distribution curve of all cases found in the NTDB. A two-way sensitivity analysis was also used to determine the impact of data uncertainty on medical costs and the reduction in trauma center visits (12%) after implementation of the 2006 Field Triage guideline compared with the 1999 Field Triage guideline. Results. At a 40% overtriage rate, the average case cost was

Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on field triage

16,434. The cost average of 44.2% reduction in case costs if patients were treated in a non–trauma center compared with a trauma center was found in the literature. Implementation of the 2006 Field Triage guideline produced a

Nonfatal injuries following Hurricane Katrina-New Orleans, Louisiana, 2005

7,264 cost savings per case, or an estimated annual national savings of

Recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings and other mass-casualty events--United States, 2008: recommendations of the Centers for Disease Control and Prevention (CDC).

568,000,000. Conclusion. Application of the 2006 Field Triage guideline helps emergency medical services personnel manage overtriage in trauma centers, which could result in a significant national cost savings.