[Fwd: Level I and II trauma center study]

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Some interesting comments from Dr. Keith Wesley on that recent level I 
vs. level II trauma center paper.

-------- Original Message --------
Subject: 	[EMS-L] Level I and II trauma center study
Date: 	Sat, 15 Oct 2005 15:34:03 -0500
From: 	Keith Wesley <drwesley at charter.net

	

	



You have to read the whole paper to see that this represents the worst 
case of data dredging.
 
First, about 40% of cases came from Level I, 10% from Level II and 50% 
from "other centers" which they lumped into the counting of Level II 
centers
 
Second, they only looked at 8 severe injuries which have the greatest 
mortality regardless of the center status but with the lumping of Level 
II and below centers together or course the survival was better.
 
Third, they make sweeping generalizations without proof and don't seem 
to really understand the fundamental difference in Level I and Level II 
verification criteria. Even given their misunderstanding of the 
differences they fail to determine what feature in the Level II centers 
is contributing to the increased mortality.
 
I'm afraid this is just another chest thumping "we're the best" type of 
paper and will have the ill effect of causing some Level II centers to 
say to hell with it and downgrade to a Level III status. We need to look 
more closely at the data than this paper does to determine for what 
cases do Level II centers do just as well as Level I so that what we 
come up with is a list of injuries for which Level I is best suited.
 
Keith Wesley, MD
EMS Consulting & Education
Eau Claire, WI

-- 

Sue Roundy, M.Ed., EMT-P (ret.)
Adjunct Instructor, National Center for Biomedical Research 
     & Training/Academy of Counter-Terrorist Training/LSU, US DHS.
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(ret.) Captain & President, Dayton (NV) Volunteer Fire Department 
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