OBJECTIVE: To determine if risk of death for hospitalized injured patients changes when an urban trauma system is implemented. DESIGN: An analysis of the risk of death in hospitalized injured patients in 1984 and 1985 (pretrauma system), 1986 and 1987 (early trauma system), and 1990 and 1991 (established trauma system) using hospital discharge abstract data. SETTING: A total of 18 acute care hospitals in the four-county area encompassing Portland, Ore. PATIENTS: A cohort of 70,350 hospitalized patients with at least one discharge diagnosis indicating injury. MAIN OUTCOME MEASURE: Death during hospitalization. RESULTS: After the trauma system was established, 77% of patients in the region with an Injury Severity Score (ISS) of 16 or greater were admitted to level I trauma centers. More than 72% of patients with an ISS less than 16 were hospitalized in nontrauma centers. Risk of death for injured patients hospitalized at level I trauma centers declined after the trauma system was established (odds ratio, 0.65; 95% confidence interval, 0.51 to 0.81). Patients who died in trauma centers after institution of the trauma system were younger and had more severe injuries, and the majority died within 1 day of admission, whereas patients who died in nontrauma centers died a median of 5 days after admission. CONCLUSION: Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.
OBJECTIVE: To determine if risk of death for hospitalized injured patients changes when an urban trauma system is implemented. DESIGN: An analysis of the risk of death in hospitalized injured patients in 1984 and 1985 (pretrauma system), 1986 and 1987 (early trauma system), and 1990 and 1991 (established trauma system) using hospital discharge abstract data. SETTING: A total of 18 acute care hospitals in the four-county area encompassing Portland, Ore. PATIENTS: A cohort of 70,350 hospitalized patients with at least one discharge diagnosis indicating injury. MAIN OUTCOME MEASURE: Death during hospitalization. RESULTS: After the trauma system was established, 77% of patients in the region with an Injury Severity Score (ISS) of 16 or greater were admitted to level I trauma centers. More than 72% of patients with an ISS less than 16 were hospitalized in nontrauma centers. Risk of death for injured patients hospitalized at level I trauma centers declined after the trauma system was established (odds ratio, 0.65; 95% confidence interval, 0.51 to 0.81). Patients who died in trauma centers after institution of the trauma system were younger and had more severe injuries, and the majority died within 1 day of admission, whereas patients who died in nontrauma centers died a median of 5 days after admission. CONCLUSION: Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.
Authors: Craig D Newgard; Dana Zive; James F Holmes; Eileen M Bulger; Kristan Staudenmayer; Michael Liao; Thomas Rea; Renee Y Hsia; N Ewen Wang; Ross Fleischman; Jonathan Jui; N Clay Mann; Jason S Haukoos; Karl A Sporer; K Dean Gubler; Jerris R Hedges Journal: J Am Coll Surg Date: 2011-12 Impact factor: 6.113
Authors: Craig D Newgard; Michael Kampp; Maria Nelson; James F Holmes; Dana Zive; Thomas Rea; Eileen M Bulger; Michael Liao; John Sherck; Renee Y Hsia; N Ewen Wang; Ross J Fleischman; Erik D Barton; Mohamud Daya; John Heineman; Nathan Kuppermann Journal: J Trauma Acute Care Surg Date: 2012-05 Impact factor: 3.313
Authors: Yoko Nakamura; Mohamud Daya; Eileen M Bulger; Martin Schreiber; Robert Mackersie; Renee Y Hsia; N Clay Mann; James F Holmes; Kristan Staudenmayer; Zachary Sturges; Michael Liao; Jason Haukoos; Nathan Kuppermann; Erik D Barton; Craig D Newgard Journal: Ann Emerg Med Date: 2012-05-24 Impact factor: 5.721
Authors: Craig D Newgard; N Clay Mann; Renee Y Hsia; Eileen M Bulger; O John Ma; Kristan Staudenmayer; Jason S Haukoos; Ritu Sahni; Nathan Kuppermann Journal: Acad Emerg Med Date: 2013-09 Impact factor: 3.451
Authors: Grant V Bochicchio; Manjari Joshi; Kelly Bochicchio; Diane Shih; W Meyer; Thomas M Scalea Journal: World J Surg Date: 2006-01 Impact factor: 3.352
Authors: Craig D Newgard; Derek Richardson; James F Holmes; Thomas D Rea; Renee Y Hsia; N Clay Mann; Kristan Staudenmayer; Erik D Barton; Eileen M Bulger; Jason S Haukoos Journal: Prehosp Emerg Care Date: 2014-06-16 Impact factor: 3.077
Authors: Craig D Newgard; Robert H Schmicker; Jerris R Hedges; John P Trickett; Daniel P Davis; Eileen M Bulger; Tom P Aufderheide; Joseph P Minei; J Steven Hata; K Dean Gubler; Todd B Brown; Jean-Denis Yelle; Berit Bardarson; Graham Nichol Journal: Ann Emerg Med Date: 2009-09-23 Impact factor: 5.721