Format

Send to

Choose Destination
Arch Surg. 2008 Feb;143(2):115-9; discussion 120. doi: 10.1001/archsurg.2007.29.

Moving beyond personnel and process: a case for incorporating outcome measures in the trauma center designation process.

Author information

1
Division of Burn, Trauma, and Surgical Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9158, USA. shahid.shafi@utsouthwestern.edu

Abstract

HYPOTHESIS:

Similarly designated trauma centers do not achieve similar outcomes.

DESIGN:

Outcomes study.

SETTING:

Academic research.

PARTICIPANTS:

Forty-seven American College of Surgeons-verified level I trauma centers that contributed more than 1000 patients to the National Trauma Data Bank (from January 1999 to December 2003) were identified.

MAIN OUTCOME MEASURES:

Patients were classified into the following 3 injury severity groups using a combination of anatomical and physiological measures: mild (Injury Severity Score [ISS] of <25 with systolic blood pressure [SBP] of >/=90 mm Hg [n = 184 650]), moderate (ISS of >/=25 with SBP of >/=90 mm Hg or ISS of <25 with SBP of <90 mm Hg [n = 22 586]), and severe (ISS of >/=25 with SBP of <90 mm Hg [n = 4243]). The mean survival for each group was calculated. Individual centers were considered outliers if their patient survival was statistically significantly different from the mean survival for each severity group.

RESULTS:

The mean survival of patients with mild, moderate, and severe injuries was 99%, 75%, and 35%, respectively. For mild injuries, survival at 5 centers (11%) was significantly worse than that at their counterpart centers. With increasing injury severity, the percentages of outcome disparities increased (15% of centers for moderate injuries and 21% of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries, and older (>55 years) individuals.

CONCLUSIONS:

When treating patients with similar injury severity, similarly designated level I trauma centers may not achieve similar outcomes, suggesting the existence of a quality chasm in trauma care. Trauma center verification may require the use of outcome measures when determining trauma center status.

PMID:
18283135
DOI:
10.1001/archsurg.2007.29
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center