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Mon Jun 29 18:48:20 BST 2009

Sadly, this discussion misses the point that inclusive trauma systems
means that rapid access to trauma care requires some patients to go to
LII-IV (or even V) before they the LI, if needed.  If the only source of
trauma care in the US is LI there are fewer than 200 centers for
thousands of patients.  Dr. Bonta has an excellent point.  Many states
have NO Level I's and furthermore do not require or even recognize ACS
verification.  If you wish for a perfect system, you have to have ALS
ground, airmedical (currently under scrutiny by the FAA for safety and
regulation issues - S 848) or other means to get to the LI which will
likely drown in overload (the most recent Congressional sample of trauma
centers showed none had any surge capacity). Let's be glad that there
are LI's when we need them.  But when you live or travel through the
outposts of America, you should be glad to be served by a committed
LII-V.  Look at the studies from OR and WA before and after
implementation of inclusive systems by Dr. Jurkovich and Nathens, et
al...  There is no perfect system.   

Connie Potter, RN, MBA

-----Original Message-----
From: Gross, Ronald [mailto:Ronald.Gross at baystatehealth.org] 
Sent: Friday, June 12, 2009 5:36 AM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: Study: Trauma Centers Aren't All Equal

Ronald I. Gross, MD, FACS
Chief of Trauma & Emergency Surgery Services
Baystate Medical Center
Assistant Professor of Surgery
Tufts University School of Medicine
759 Chestnut Street
Springfield, MA  01199
413-794-4022  phone
413-794-0142  fax
ronald.gross at baystatehealth.org

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of S Schecter
Sent: Thursday, June 11, 2009 7:37 PM
To: Trauma &amp, Critical Care mailing list
Subject: Study: Trauma Centers Aren't All Equal

Patient survival rates highest in Level I centers, study suggests
*Suzanne
Hoholik*
The Columbus Dispatch (Ohio)

Patients have a better chance of surviving life-threatening injuries if
they're treated at a Level I trauma center than a Level II trauma
center,
according to a study by local experts.

Patients whose injuries were caused in car crashes, fires or criminal
activity might not know the difference between the two, but trauma
experts
say the data suggest that outcome can depend on where they are taken.

The authors credit the better Level I outcomes to the increased patient
volume -- at least 1,200 admissions a year -- required of such centers.
Level II centers have no volume requirement.

In medicine, the more you perform, the better you get.

The study, recently published in the Journal of Trauma, looked at the
outcomes of 18,103 injured adult patients taken to Level I and II trauma
centers by emergency medical workers between January 2003 and December
2006.

Physicians at Ohio State University Medical Center did the research and
found that although Level I centers received patients with more severe
injuries and more complications, those patients had better outcomes than
those taken to Level II centers.

Authors say this is the first time Ohio Trauma Registry data have been
analyzed to compare patient outcomes at the two kinds of trauma centers.

Trauma experts say critically injured patients fare better when matched
with
hospitals best staffed and equipped to treat them. State law requires
that
these patients be taken to trauma centers verified by the American
College
of Surgeons.

Level I and II centers have similar requirements and, for the most part,
receive similar patients.

"We assume if hospitals meet certain standards, the outcome is good,"
said
Dr. Steve M. Steinberg, director of critical care, trauma and burns at
OSU
Medical Center and co-author of the study.

"Our intent is to determine if that is true or not."

According to the study, patients taken to Level I centers had better
survival rates and were more likely to be discharged rather than sent to
rehabilitation centers.

There are 11 adult Level I trauma centers in Ohio, including Ohio State
and
Grant Medical Center. There also are 11 Level II trauma centers in the
state, including Mount Carmel West hospital and Riverside Methodist
Hospital, which, like Grant, is owned by OhioHealth.

Last year, OSU Medical Center treated 1,459 trauma patients; Grant,
3,447;
Riverside, 2,043; and Mount Carmel, 929.

The study found, for example, that patients with traumatic head injuries
increase their odds of survival by 34 percent by being treated at Level
I
centers. And for patients with pelvic fractures, the odds of surviving
improve by 51 percent at Level I centers.

The study also found that patients with penetrating injuries -- such as
cuts
and gunshot wounds -- are 30 percent more likely to be sent home without
rehabilitation from a Level I center, as compared with a Level II
center.

Dr. Marco Bonta, director of trauma
services<http://www.emsresponder.com/online/article.jsp?siteSection=24&i
d=9679#>at
Riverside, noted that more than 2,000 trauma patients were admitted
there
last year.

Bonta said lumping data from all Level II centers, no matter the
location or
patient volume, is a flaw of the study.

"Riverside should be compared to centers of the same size," Bonta said.
"Our
outcomes are good ... I'd hold them up against any of these (Level I)
hospitals."

The study's authors say this research is a starting point to further
examine
the state's trauma system, which was created in 2003.

"This definitely opens the door to interesting questions to
investigate,"
said Dr. Michael Cudnik, an OSU emergency room doctor and co-author of
the
study.

His next study will look at outcomes of just Level I trauma centers
across
the state.

Dr. David Keseg, medical director of the Columbus Division of Fire, said
more research is needed before paramedics should consider changing their
protocols.

If the EMS protocols were to change, it could be a burden for the city's
two
Level I centers. \ "It would be difficult for Level I trauma centers to
accommodate the increased volume," said Dr. Steven Santanello, vice
president of surgical and trauma services at Grant Medical Center.
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