Trauma center levels ca windows#
The following data were included in a computerized spreadsheet and analyzed using SPSS 12.0 Windows (SPSS Inc, Chicago, Illinois) for the purpose of the study: age gender mechanism of injury (blunt or penetrating) hypotension on admission (systolic blood pressure ≤90 mm Hg or >90 mm Hg) abbreviated injury score (AIS) for head, chest, abdomen, and extremities injury severity score (ISS) severe liver trauma (International Classification of Diseases, 9th Revision codes 864.04, 864.09, 864.14, 864.19) penetrating cardiac injuries (861.03, 861.12) aortic injuries (901.0, 902.0) vena cava injuries (901.2, 902.0) iliac vascular injuries (902.53, 902.54, 902.50) quadriplegia (806.01, 806.06, 806.11, 806.16) and complex pelvic fractures (808.43, 808.53). The study included trauma patients older than 14 years of age who were alive on admission to the hospital and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, grade IV/V liver injuries, penetrating cardiac injuries, quadriplegia, or complex pelvic fractures ( Table 1) during the period 1996 through 2003. The number of admissions of patients with an ISS greater than 15 per year was also collected for each participating center. The ACS trauma level designation for each facility was categorized as level I, level II, or other. In addition to the patient-specific data, information for each admission was collected regarding the treating hospital. The database contains information on patient demographics, prehospital care, diagnoses and injury severity scoring, inpatient care and complications, as well as outcomes. This ongoing project represents the largest trauma registry ever assembled and currently contains over one million prospectively collected patient records. Overall, level I centers had significantly lower mortality (25.3% vs 29.3% adjusted odds ratio, 0.81 95% confidence interval, 0.71–0.94 P = 0.004) and significantly lower severe disability at discharge (20.3% vs 33.8%, adjusted OR, 0.55 95% CI, 0.44–0.69 P 15 (<240 vs ≥240 cases per year) had no effect on outcome in either level I or II centers.ĭata for this study was obtained from the National Trauma Data Bank (NTDB), which is maintained by the American College of Surgeons. A total of 12,254 patients met the inclusion criteria.
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