Decreased Intracranial Pressure Monitor Use at Level II Trauma Centers is Associated with Increased Mortality

2012 ◽  
Vol 78 (10) ◽  
pp. 1166-1171 ◽  
Author(s):  
Galinos Barmparas ◽  
Matthew Singer ◽  
Eric Ley ◽  
Rex Chung ◽  
Darren Malinoski ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Trauma Center ◽  
Injury Severity ◽  
Regression Modeling ◽  
Trauma Centers ◽  
Icp Monitoring ◽  
Pressure Monitor ◽  
Brain Trauma Foundation ◽  
Level Ii ◽  
Level I

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P < 0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P < 0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P < 0.01) and had a significantly higher mortality (AOR, 1.12; P < 0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers.

Pediatric Trauma System Evaluation before and after Level II Verification

2019 ◽  
Vol 85 (11) ◽  
pp. 1281-1287
Author(s):  
Michael D. Dixon ◽  
Scott Engum
Keyword(s):  
Native American ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I ◽  
Pediatric Trauma Center

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

Should All Severely Injured Pediatric Patients be Treated at Pediatric Level I Trauma Centers? A National Trauma Data Bank Study

2015 ◽  
Vol 81 (10) ◽  
pp. 927-931
Author(s):  
Shin Miyata ◽  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Kazuhide Matsushima ◽  
Catherine Goodhue ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
Level Ii ◽  
National Trauma Data Bank ◽  
Level I

The American College of Surgeons Committee on Trauma stratification system for trauma centers presumes that increasing levels of resources will improve patient outcomes. Although some supportive data exist in adult trauma, there is a paucity of evidence demonstrating improved survival in pediatric trauma when patients are treated primarily at Level I versus Level II pediatric trauma centers. We hypothesized that there is no difference in the mortality of comparably injured pediatric patients treated at these two types of facilities. The study population consists of all severely injured pediatric patients (18 years old or younger, injury severity score > 15) registered in the National Trauma Data Bank, treated in designated pediatric trauma centers. A total of 13,803 patients were included in the analysis and were separated into two groups: Pediatric Level I trauma center (n = 9690) and Pediatric Level II trauma center (n = 4113). Although analysis of the clinical characteristics of the unmatched groups showed significant differences including mortality rate (11.7% vs 15.4%, P < 0.001), case matching technique, comparing 2956 pairs, successfully eliminated demographic differences and, when adjusted for injury severity, showed no difference in mortality between center types (10.0% vs 10.1%, P = 0.966, odds ratio of mortality = 0.996 and 95% confidence interval = 0.841–1.180). Subgroup analyses including Glasgow Coma Scale < 9, need for immediate procedures, and ICD-9 (International Classification of Diseases) code groupings indicative of serious injury also failed to demonstrate statistically significant differences in mortality between trauma center types.

Initial Approach to the Management of Multisystem Trauma

2019 ◽  
pp. 397-401
Author(s):  
David S. Morris
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Hospital Admissions ◽  
The United States ◽  
Emergency Department Visits ◽  
Severely Injured ◽  
Level Ii ◽  
Level I ◽  
Nonfatal Injuries ◽  
Injured Patients

Nearly 200,000 people die of injury-related causes in the United States each year, and injury is the leading cause of death for all patients aged 1 to 44 years. Approximately 30 million people sustain nonfatal injuries each year, which results in about 29 million emergency department visits and 3 million hospital admissions. Management of severely injured patients, typically defined as having an Injury Severity Score greater than 15 is best managed in a level I or level II trauma center. Any physician who provides care for critically ill patients should have a basic familiarity with the fundamentals of trauma care.

Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

2022 ◽  
pp. 000313482110335
Author(s):  
Aryan Haratian ◽  
Areg Grigorian ◽  
Karan Rajalingam ◽  
Matthew Dolich ◽  
Sebastian Schubl ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Trauma Center ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Improvement Program ◽  
Blunt Abdominal Injury ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I

Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.

Impact of adding Level II and III trauma centers on volume and disease severity at a nearby Level I trauma center

2014 ◽  
Vol 77 (5) ◽  
pp. 764-768 ◽  
Author(s):  
Brendan G. Carr ◽  
Juliet Geiger ◽  
Nathan McWilliams ◽  
Patrick M. Reilly ◽  
Douglas J. Wiebe
Keyword(s):  
Disease Severity ◽  
Trauma Center ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I

The G60 Trauma Center: A Future Consideration?

2017 ◽  
Vol 83 (6) ◽  
pp. 547-553 ◽  
Author(s):  
Marko Bukur ◽  
Joshua Simon ◽  
Joseph Catino ◽  
Margaret Crawford ◽  
Ivan Puente ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Trauma Center ◽  
Injury Severity ◽  
Head Injuries ◽  
Major Complication ◽  
The Elderly ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Failure To Rescue ◽  
Level I

With a considerably increasing elderly population, we sought to determine whether the volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. This is a retrospective review of all elderly patients (>60 years) at two state-verified Level I trauma centers over the past five years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Demographic and clinical characteristics were abstracted and stratified into ETC and TC groups for comparison. Primary outcomes were overall postinjury complication and mortality rates, as well as death after major complication (failure to rescue). ETC patients were older (78.6 vs 70.5), more likely to be admitted with severe head injuries (head abbreviated injury score ≥ 3, 50.0% vs 32%), had a greater overall injury burden (injury severity score > 16 41.4% vs 21.1%), and required intensive care unit admission (81.3% vs 64%) than the TC group. Need for operative intervention, mechanism of injury, and comorbidities were similar between the two groups. Overall complications were higher in trauma patients admitted to the TC (21.9% vs 14.3%), as well as failure to rescue (4.0% vs 1.8%). Adjusting for confounding factors, ETC had significantly lower chance of developing a postinjury complication (adjusted odds ratios [AOR] = 0.4, 95% confidence interval [CI] = [0.3, 0.5]), failure to rescue (AOR = 0.3, 95% CI = [0.1, 0.5]), and overall mortality (AOR = 0.3, 95% CI = [0.2, 0.4]). Improved outcomes were demonstrated in the Level I center treating a higher proportion of elderly patients. Exact etiology of these benefits should be determined for quality improvement in care of the injured geriatric patient.

Impact of Trauma Center Designation on Outcomes: Is There a Difference Between Level I and Level II Trauma Centers?

2012 ◽  
Vol 215 (3) ◽  
pp. 372-378 ◽  
Author(s):  
Laurent G. Glance ◽  
Turner M. Osler ◽  
Dana B. Mukamel ◽  
Andrew W. Dick
Keyword(s):  
Trauma Center ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I

scholarly journals Intracranial pressure monitoring following traumatic brain injury: evaluation of indications, complications, and significance of follow-up imaging—an exploratory, retrospective study of consecutive patients at a level I trauma center

2020 ◽  
Author(s):  
Alexander Bumberger ◽  
Tomas Braunsteiner ◽  
Johannes Leitgeb ◽  
Thomas Haider
Keyword(s):  
Traumatic Brain Injury ◽  
Intracranial Pressure ◽  
Trauma Center ◽  
Surgical Intervention ◽  
Clinical Deterioration ◽  
Icp Monitoring ◽  
Severe Tbi ◽  
Level I ◽  
Increased Icp

Abstract Background Measurement of intracranial pressure (ICP) is an essential part of clinical management of severe traumatic brain injury (TBI). However, clinical utility and impact on clinical outcome of ICP monitoring remain controversial. Follow-up imaging using cranial computed tomography (CCT) is commonly performed in these patients. This retrospective cohort study reports on complication rates of ICP measurement in severe TBI patients, as well as on findings and clinical consequences of follow-up CCT. Methods We performed a retrospective clinical chart review of severe TBI patients with invasive ICP measurement treated at an urban level I trauma center between January 2007 and September 2017. Results Clinical records of 213 patients were analyzed. The mean Glasgow Coma Scale (GCS) on admission was 6 with an intra-hospital mortality of 20.7%. Overall, complications in 12 patients (5.6%) related to the invasive ICP-measurement were recorded of which 5 necessitated surgical intervention. Follow-up CCT scans were performed in 192 patients (89.7%). Indications for follow-up CCTs included routine imaging without clinical deterioration (n = 137, 64.3%), and increased ICP values and/or clinical deterioration (n = 55, 25.8%). Follow-up imaging based on clinical deterioration and increased ICP values were associated with significantly increased likelihoods of worsening of CCT findings compared to routinely performed CCT scans with an odds ratio of 5.524 (95% CI 1.625–18.773) and 6.977 (95% CI 3.262–14.926), respectively. Readings of follow-up CCT imaging resulted in subsequent surgical intervention in six patients (3.1%). Conclusions Invasive ICP-monitoring in severe TBI patients was safe in our study population with an acceptable complication rate. We found a high number of follow-up CCT. Our results indicate that CCT imaging in patients with invasive ICP monitoring should only be considered in patients with elevated ICP values and/or clinical deterioration.

A Contemporary Analysis of the Effect of Trauma Center Verification Level on Mortality in Severe Injury

2021 ◽  
pp. 000313482110234
Author(s):  
David S. Plurad ◽  
Glenn Geesman ◽  
Nicholas W. Sheets ◽  
Bhani Chawla-Kondal ◽  
Napatakamon Ayutyanont ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Severely Injured ◽  
Adult Age ◽  
Program Participant ◽  
Level Ii ◽  
Level I ◽  
Verification Process ◽  
Injured Patients ◽  
The Impact

Background Literature demonstrates increased mortality for the severely injured at a Level II vs. Level I center. Our objective is to reevaluate the impact of trauma center verification level on mortality for patients with an Injury Severity Score (ISS) > 15 utilizing more contemporary data. We hypothesize that there would be no mortality discrepancy. Study Design Utilizing the ACS Trauma Quality Program Participant Use File admission year 2017, we identified severely injured (ISS >15) adult (age >15 years) patients treated at an ACS-verified Level I or Level II center. We excluded patients who underwent interfacility transfer. Logistic regression was performed to determine adjusted associations with mortality. Results There were 63 518 patients included, where 43 680 (68.8%) were treated at a Level I center and 19 838 (31.2%) at a Level II. Male gender (70.1%) and blunt injuries (92.0%) predominated. Level I admissions had a higher mean ISS [23.8 (±8.5) vs. 22.9 (±7.8), <.001], while Level II patients were older [mean age (y) 52.3 (±21.6) vs. 48.6 (±21.0), <.001] with multiple comorbidities (37.7% vs. 34.9%, <.001). Adjusted mortality between Level I and II centers was similar (12.0% vs. 11.8%, .570). Conclusions Despite previous findings, mortality outcomes are similar for severely injured patients treated at a Level I vs. Level II center. We theorize that this relates to mandated Level II resourcing as defined by an updated American College of Surgeons verification process.

scholarly journals Primary admission and secondary transfer of trauma patients to Dutch level I and level II trauma centers: predictors and outcomes

2021 ◽  
Author(s):  
Claire R. L. van den Driessche ◽  
Charlie A. Sewalt ◽  
Jan C. van Ditshuizen ◽  
Lisa Stocker ◽  
Michiel H. J. Verhofstad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Trauma Center ◽  
Regression Models ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Logistic Regression Models ◽  
Level Ii ◽  
Secondary Transfer ◽  
Level I

Abstract Purpose The importance and impact of determining which trauma patients need to be transferred between hospitals, especially considering prehospital triage systems, is evident. The objective of this study was to investigate the association between mortality and primary admission and secondary transfer of patients to level I and II trauma centers, and to identify predictors of primary and secondary admission to a designated level I trauma center. Methods Data from the Dutch Trauma Registry South West (DTR SW) was obtained. Patients ≥ 18 years who were admitted to a level I or level II trauma center were included. Patients with isolated burn injuries were excluded. In-hospital mortality was compared between patients that were primarily admitted to a level I trauma center, patients that were transferred to a level I trauma center, and patients that were primarily admitted to level II trauma centers. Logistic regression models were used to adjust for potential confounders. A subgroup analysis was done including major trauma (MT) patients (ISS > 15). Predictors determining whether patients were primarily admitted to level I or level II trauma centers or transferred to a level I trauma center were identified using logistic regression models. Results A total of 17,035 patients were included. Patients admitted primarily to a level I center, did not differ significantly in mortality from patients admitted primarily to level II trauma centers (Odds Ratio (OR): 0.73; 95% confidence interval (CI) 0.51–1.06) and patients transferred to level I centers (OR: 0.99; 95%CI 0.57–1.71). Subgroup analyses confirmed these findings for MT patients. Adjusted logistic regression analyses showed that age (OR: 0.96; 95%CI 0.94–0.97), GCS (OR: 0.81; 95%CI 0.77–0.86), AIS head (OR: 2.30; 95%CI 2.07–2.55), AIS neck (OR: 1.74; 95%CI 1.27–2.45) and AIS spine (OR: 3.22; 95%CI 2.87–3.61) are associated with increased odds of transfers to a level I trauma center. Conclusions This retrospective study showed no differences in in-hospital mortality between general trauma patients admitted primarily and secondarily to level I trauma centers. The most prominent predictors regarding transfer of trauma patients were age and neurotrauma. These findings could have practical implications regarding the triage protocols currently used.

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