Patricia Southard

Influence of a statewide trauma system on location of hospitalization and outcome of injured patients

OBJECTIVE Evaluate the influence of implementing the Oregon statewide trauma system on admission distribution and risk of death. DESIGN Retrospective pre- and posttrauma system analyses of hospital discharge data regarding injured patients with one or more of the following injuries: head, chest, spleen/liver, pelvic fracture, and femur/tibia fracture. MATERIALS AND METHODS Risk-adjusted odds ratio of admission to Level I or II (tertiary care) trauma centers, and odds ratio of death were determined using hospital discharge abstract data on 27,633 patients. Patients treated in 1985-1987, before trauma system establishment, were compared to patients treated in 1991-1993 after the trauma system was functioning. MEASUREMENTS AND MAIN RESULTS After trauma system implementation, the odds ratio of admission to Level I or II trauma centers increased (odds ratio 2.36, 95% confidence interval 2.24-2.49). In addition, the odds ratio of death for injured patients declined after trauma system establishment (odds ratio 0.82, confidence interval 0.73-0.92). CONCLUSIONS The Oregon trauma system was successfully implemented with more patients with index injuries admitted to hospitals judged most capable of managing trauma patients. The Oregon trauma system also appears beneficial since trauma system establishment is associated with a statewide reduction in risk of death.

Triage in an established trauma system

OBJECTIVE The goal of this study was to determine patient and injury characteristics that predict undertriage and overtriage. DESIGN This study was a retrospective analysis of admissions for acute injury. MATERIALS AND METHODS All admissions for acute injuries in a 2 1/2-year period were included (N = 26,025). ICD-9 clinical modification codes were converted to Injury Severity Scores. MAIN RESULTS Seventy-nine percent of severely injured patients were admitted to level I trauma centers. Severely injured patients admitted to other hospitals (undertriage) were more likely elderly (odds ratio = 5.44) and less likely had multisystem injuries (odds ratio = 0.55). One-fourth of patients with minor injuries were admitted to level I trauma centers (overtriage). Overtriaged patients were more likely intoxicated, obese, or had an injury to the head or face. CONCLUSIONS In a developed trauma system, severely injured elderly trauma patients (especially females) are at risk for undertriage. The characteristics of patients at risk for overtriage reflect the difficulties of prospective out-of-hospital triage.

Financial Strategies and Outcomes Management in Trauma Care: Current Status and Predictions for the Future

In the competitive health care market of the 1990s, trauma centers face a multitude of fiscal challenges that threaten their survival. Trauma centers are confronted with the tremendous task of balancing the cost of caring for the patient with multiple trauma who requires resource-intensive care with the most fiscally responsible outcomes. Academic medical centers and residency training programs are faced with an even greater burden associated with controlling cost while providing learning experiences for physicians and nurses. Outcomes management represents the future strategy that trauma centers nationwide must embrace. Outcomes management gives trauma centers the opportunity to demonstrate their contribution to the community and society through improved patient and systems outcomes.