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Journal articles on the topic 'Trauma centers'

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Published: 4 June 2021
Last updated: 28 July 2024

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1

Rosenfeld, Joel C. "Trauma surgeons and trauma centers." Current Surgery 56, no. 9 (November 1999): 503–8. http://dx.doi.org/10.1016/s0149-7944(99)00190-7.

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2

Trunkey, Donald D. "Trauma Centers and Trauma Systems." JAMA 289, no. 12 (March 26, 2003): 1566. http://dx.doi.org/10.1001/jama.289.12.1566.

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3

SMITH, J. STANLEY, LOUIS F. MARTIN, WANDA W. YOUNG, and DARREN P. MACIOCE. "Do Trauma Centers Improve Outcome over Non-Trauma Centers." Journal of Trauma: Injury, Infection, and Critical Care 30, no. 12 (December 1990): 1533–38. http://dx.doi.org/10.1097/00005373-199012000-00017.

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4

Moore, Ernest E. "Trauma Systems, Trauma Centers, and Trauma Surgeons." Journal of Trauma: Injury, Infection, and Critical Care 39, no. 1 (July 1995): 1–11. http://dx.doi.org/10.1097/00005373-199507000-00001.

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5

Hall, Kelly, and Armelle deLaforcade. "Veterinary Trauma Centers." Journal of Veterinary Emergency and Critical Care 23, no. 4 (July 2013): 373–75. http://dx.doi.org/10.1111/vec.12077.

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6

Notrica, David M., Jeffrey Weiss, Pamela Garcia-Filion, Erin Kuroiwa, Daxa Clarke, Melissa Harte, Jenessa Hill, and Sally Moffat. "Pediatric trauma centers." Journal of Trauma and Acute Care Surgery 73, no. 3 (September 2012): 566–72. http://dx.doi.org/10.1097/ta.0b013e318265ca6f.

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7

Moore, Kathryn. "Understanding Trauma Systems and Trauma Centers." Journal of Emergency Nursing 41, no. 6 (November 2015): 540–41. http://dx.doi.org/10.1016/j.jen.2015.08.016.

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8

Jenkins, Peter C., Lava Timsina, Patrick Murphy, Christopher Tignanelli, Daniel N. Holena, Mark R. Hemmila, and Craig Newgard. "Extending Trauma Quality Improvement Beyond Trauma Centers." Annals of Surgery 275, no. 2 (October 20, 2021): 406–13. http://dx.doi.org/10.1097/sla.0000000000005258.

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9

Aprahamian, Charles, James R. Wallace, Jack M. Bergstein, and Robert Zeppa. "CHARACTERISTICS OF TRAUMA CENTERS AND TRAUMA SURGEONS." Journal of Trauma: Injury, Infection, and Critical Care 35, no. 4 (October 1993): 562–68. http://dx.doi.org/10.1097/00005373-199310000-00011.

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10

Clemmer, Terry P. "Triage to trauma centers." Annals of Emergency Medicine 15, no. 5 (May 1986): 602. http://dx.doi.org/10.1016/s0196-0644(86)81004-6.

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11

Mueller, Charles F. "Trauma centers: Radiologists’ role." Emergency Radiology 2, no. 3 (May 1995): 119. http://dx.doi.org/10.1007/bf02615788.

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12

Tarima, Sergey, Allison Ertl, Jonathan I. Groner, and Laura D. Cassidy. "Factors associated with patients transferred from undesignated trauma centers to trauma centers." Journal of Trauma and Acute Care Surgery 79, no. 3 (September 2015): 378–85. http://dx.doi.org/10.1097/ta.0000000000000763.

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13

Ang, Darwin, Frederick P. Rivara, Avery Nathens, Gregory J. Jurkovich, Ronald V. Maier, Jin Wang, and Ellen J. MacKenzie. "Comparing complications among different clinical paradigms: Trauma centers versus non-trauma centers." Journal of the American College of Surgeons 205, no. 3 (September 2007): S68—S69. http://dx.doi.org/10.1016/j.jamcollsurg.2007.06.171.

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14

Cavalea, MD, Alexander C., Robin McGoey, MSGC, MD, Rebecca W. Schroll, MD, FACS, Patrick R. McGrew, MD, Jonathan E. Schoen, MD, MPH, Lance E. Stuke, MD, MPH, FACS, Chrissy Guidry, DO, FACS, Alan B. Marr, MD, FACS, Juan C. Duchesne, MD, FACS, and John P. Hunt, MD, MPH, FACS. "Maintaining trauma center operational readiness during a pandemic." American Journal of Disaster Medicine 16, no. 1 (January 1, 2021): 25–34. http://dx.doi.org/10.5055/ajdm.2021.0383.

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The coronavirus disease 2019 (COVID-19) pandemic is a slow-moving global disaster with unique challenges for maintaining trauma center operations. University Medical Center New Orleans is the only level 1 trauma center in New Orleans, LA, which became an early hotspot for COVID-19. Intensive care unit surge capacity, addressing components including space, staff, stuff, and structure, is important in maintaining trauma center operability during a high resource-strain event like a pandemic. We report management of the trauma center’s surge capacity to maintain trauma center operations while assisting in the care of critically ill COVID-19 patients. Lessons learned and recommendations are provided to assist trauma centers in planning for the influx of COVID-19 patients at their centers.
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15

Ashley, Dennis W., Robert F. Mullins, Christopher J. Dente, Laura Garlow, Regina S. Medeiros, Elizabeth V. Atkins, Gina Solomon, Dena Abston, and Colville H. Ferdinand. "What are the Costs of Trauma Center Readiness? Defining and Standardizing Readiness Costs for Trauma Centers Statewide." American Surgeon 83, no. 9 (September 2017): 979–85. http://dx.doi.org/10.1177/000313481708300935.

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Trauma center readiness costs are incurred to maintain essential infrastructure and capacity to provide emergent services on a 24/7 basis. These costs are not captured by traditional hospital cost accounting, and no national consensus exists on appropriate definitions for each cost. Therefore, in 2010, stakeholders from all Level I and II trauma centers developed a survey tool standardizing and defining trauma center readiness costs. The survey tool underwent minor revisions to provide further clarity, and the survey was repeated in 2013. The purpose of this study was to provide a follow-up analysis of readiness costs for Georgia's Level I and Level II trauma centers. Using the American College of Surgeons Resources for Optimal Care of the Injured Patient guidelines, four readiness cost categories were identified: Administrative, Clinical Medical Staff, Operating Room, and Education/Outreach. Through conference calls, webinars and face-to-face meetings with financial officers, trauma medical directors, and program managers from all trauma centers, standardized definitions for reporting readiness costs within each category were developed. This resulted in a survey tool for centers to report their individual readiness costs for one year. The total readiness cost for all Level I trauma centers was $34,105,318 (avg $6,821,064) and all Level II trauma centers was $20,998,019 (avg $2,333,113). Methodology to standardize and define readiness costs for all trauma centers within the state was developed. Average costs for Level I and Level II trauma centers were identified. This model may be used to help other states define and standardize their trauma readiness costs.
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16

Lassiter, Randi L., Dennis W. Ashley, Regina S. Medeiros, Bao-ling Adam, Elizabeth G. Nesmith, Tracy J. Johns, Elizabeth V. Atkins, Christopher J. Dente, and Colville H. Ferdinand. "Descriptive Analysis of Venous Thromboembolism in Georgia Trauma Centers Compared with National Trauma Centers Participating in the Trauma Quality Improvement Program." American Surgeon 83, no. 11 (November 2017): 1283–88. http://dx.doi.org/10.1177/000313481708301132.

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This study was designed to compare the incidence of venous thromboembolism (VTE) in Georgia trauma centers with other national trauma centers participating in the Trauma Quality Improvement Program (TQIP). The use of chemoprophylaxis and characteristics of patients who developed VTE were also examined. We conducted a retrospective observational study of 325,703 trauma admissions to 245 trauma centers from 2013 to 2014. Patient demographics, rate of VTE, as well as the use, type, and timing of chemoprophylaxis were compared between patients admitted to Georgia and non-Georgia trauma centers. The rate of VTE in Georgia trauma centers was 1.9 per cent compared with 2.1 per cent in other national trauma centers. Overall, 49.6 per cent of Georgia patients and 45.5 per cent of patients in other trauma centers had documented chemoprophylaxis. Low molecular weight heparin was the most commonly used medication. Most patients who developed VTE did so despite receiving prophylaxis. The rate of VTE despite prophylaxis was 3.2 per cent in Georgia and 3.1 per cent in non-Georgia trauma centers. Mortality associated with VTE was higher in Georgia trauma centers compared with national TQIP benchmarks. The incidence of VTE and use of chemoprophylaxis within Georgia trauma centers were similar to national TQIP data. Interestingly, most patients who developed VTE in both populations received VTE prophylaxis. Further research is needed to develop best-practice guidelines for prevention, early detection, and treatment in high-risk populations.
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17

Hatchimonji, Justin S., Elinore J. Kaufman, Andrew J. Young, Brian P. Smith, Ruiying Xiong, Patrick M. Reilly, and Daniel N. Holena. "High-Performance Trauma Centers in a Single-State Trauma System." American Surgeon 86, no. 7 (July 2020): 766–72. http://dx.doi.org/10.1177/0003134820934415.

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Background Trauma centers with low observed:expected (O:E) mortality ratios are considered high performers; however, it is unknown whether improvements in this ratio are due to a small number of unexpected survivors with high mortality risk (big saves) or a larger number of unexpected survivors with moderate mortality risk (marginal gains). We hypothesized that the highest-performing centers achieve that status via larger numbers of unexpected survivors with moderate mortality risk. Methods We calculated O:E ratios for trauma centers in Pennsylvania for 2016 using a risk-adjusted mortality model. We identified high and low performers as centers whose 95% CIs did not cross 1. We visualized differences between these centers by plotting patient-level observed and expected mortality; we then examined differences in a subset of patients with a predicted mortality of ≥10% using the chi-squared test. Results One high performer and 1 low performer were identified. The high performer managed a population with more blunt injuries (97.2% vs 93.6%, P < .001) and a higher median Injury Severity Score (14 vs 11, P < .001). There was no difference in survival between these centers in patients with an expected mortality of <10% (98.0% vs 96.7%, P = .11) or ≥70% (23.5% vs 10.8%, P = .22), but there was a difference in the subset with an expected mortality of ≥10% (77.5% vs 43.1%, P < .001). Conclusions Though patients with very low predicted mortality do equally well in high-performing and low-performing centers, the fact that performance seems determined by outcomes of patients with moderate predicted mortality favors a “marginal gains” theory.
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18

Salim, Ali, Cherisse Berry, Eric J. Ley, Danielle Schulman, Marko Bukur, Daniel R. Margulies, Sonia Navarro, and Darren Malinoski. "The Effect of Trauma Center Designation on Organ Donor Outcomes in Southern California." American Surgeon 78, no. 5 (May 2012): 535–39. http://dx.doi.org/10.1177/000313481207800533.

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We sought to investigate the effect of trauma center designation on organ donor outcomes during a 5-year period. A retrospective study of the southern California regional Organ Procurement Organization database comparing trauma centers (n = 25) versus nontrauma centers (n = 171) and Level I (n = 7) versus Level II (n = 18) trauma centers between 2004 and 2008 was performed. A total of 16,830 referrals were evaluated and 44 per cent were from trauma centers. When compared with nontrauma centers (n = 171), trauma centers (n = 25) had a higher percentage of medically suitable eligible deaths (29 vs 16%, P < 0.001), total eligible deaths (22 vs 12%, P < 0.001), and eligible donors (14 vs 7%, P < 0.001). Trauma Centers had a significantly higher number of organs procured per donor (4.0 ± 1.6 vs 3.5 ± 1.6, P < 0.001), organs transplanted per donor (OTPD) (3.6 ± 1.8 vs 2.8 ± 1.8, P < 0.001), and higher organ yield (per cent 4 or greater OTPD [48 vs 31%, P < 0.001]). No significant differences were found between Level I and Level II trauma centers. Trauma centers demonstrate significantly better organ donor outcomes compared with nontrauma centers. Factors responsible for improved outcomes at trauma centers should be evaluated, reproduced, and disseminated to nontrauma centers to alleviate the growing organ shortage crisis.
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19

Barmparas, Galinos, Ara Ko, Navpreet K. Dhillon, James M. Tatum, Mark Choi, Eric J. Ley, and Daniel R. Margulies. "Extreme Interventions for Trauma Patients in Extremis: Variations among Trauma Centers." American Surgeon 83, no. 10 (October 2017): 1033–39. http://dx.doi.org/10.1177/000313481708301004.

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Although guidelines for the performance of an emergency department thoracotomy (EDT) are available, high level evidence remains scarce potentially leading to variation in decisions and practices among trauma surgeons. The National Trauma Databank was queried for all subjects who died in the emergency department (ED) between 2007 and 2011. Trauma centers were divided into four quartiles based on the rate of EDTamong ED deaths. A total of 31,623 subjects admitted to 729 trauma centers met inclusion criteria. Most of of these centers (n = 328, 53%) never performed an EDT during the study period. Very few outlier centers (1.1%) performed this procedure in 50.0 per cent or more of all patients who died in the ED. Trauma centers in the highest quartiles in performing EDT were more likely to intervene with both surgical and nonsurgical procedures in patients who died in the ED, independent of the performance of an EDT. There are significant variations among trauma centers in the management of trauma patients who expire in the ED. Further research at a national level toward standardizing the management of the trauma patient in extremis and the decision to perform an EDT is necessary, given the extremely low survival associated with this procedure.
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20

Harbrecht, Brian G., Glen A. Franklin, Jason W. Smith, David S. Foley, Frank B. Miller, and J. David Richardson. "Management Differences for Pediatric Solid Organ Injuries in a Rural State." American Surgeon 75, no. 8 (August 2009): 725–29. http://dx.doi.org/10.1177/000313480907500817.

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Pediatric liver and spleen injuries are frequently treated in specialized hospitals. Not all injured children, however, are treated in referral centers. We evaluated the management of pediatric liver and spleen injuries in a rural state without a state trauma system to determine if differences existed between trauma centers and nontrauma centers. A state database was queried for patients ≤15-years-old who suffered liver and spleen injuries from 2003 to 2005. Iatrogenic injuries were excluded. There were 115 pediatric liver and 183 pediatric spleen injuries. Fifty per cent of liver and 63 per cent of spleen injuries in nontrauma centers were isolated solid organ injuries compared with 18 per cent and 36 per cent, respectively, in trauma centers. The mortality rate for both liver and spleen injuries was similar in trauma and nontrauma centers. Hospital charges were higher in trauma centers but this was due to patients with associated injuries. The nonoperative management rate was similar for liver injuries. Pediatric patients with splenic injuries had a lower rate of nonoperative management in nontrauma centers (75% to 90%, nontrauma vs trauma). In Kentucky, pediatric solid organ injuries are usually managed nonoperatively in both trauma and nontrauma centers, but trauma centers cared for fewer isolated solid organ injuries.
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21

Stey, Anne M., Alexandria Byskosh, Caryn Etkin, Robert Mackersie, Deborah M. Stein, Karl Y. Bilimoria, and Marie L. Crandall. "Describing the density of high-level trauma centers in the 15 largest US cities." Trauma Surgery & Acute Care Open 5, no. 1 (October 2020): e000562. http://dx.doi.org/10.1136/tsaco-2020-000562.

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BackgroundThere has been a proliferation of urban high-level trauma centers. The aim of this study was to describe the density of high-level adult trauma centers in the 15 largest cities in the USA and determine whether density was correlated with urban social determinants of health and violence rates.MethodsThe largest 15 US cities by population were identified. The American College of Surgeons’ (ACS) and states’ department of health websites were cross-referenced for designated high-level (levels 1 and 2) trauma centers in each city. Trauma centers and associated 20 min drive radius were mapped. High-level trauma centers per square mile and per population were calculated. The distance between high-level trauma centers was calculated. Publicly reported social determinants of health and violence data were tested for correlation with trauma center density.ResultsAmong the 15 largest cities, 14 cities had multiple high-level adult trauma centers. There was a median of one high-level trauma center per every 150 square kilometers with a range of one center per every 39 square kilometers in Philadelphia to one center per596 square kilometers in San Antonio. There was a median of one high-level trauma center per 285 034 people with a range of one center per 175 058 people in Columbus to one center per 870 044 people in San Francisco. The median minimum distance between high-level trauma centers in the 14 cities with multiple centers was 8 kilometers and ranged from 1 kilometer in Houston to 43 kilometers in San Antonio. Social determinants of health, specifically poverty rate and unemployment rate, were highly correlated with violence rates. However, there was no correlation between trauma center density and social determinants of health or violence rates.DiscussionHigh-level trauma centers density is not correlated with social determinants of health or violence rates.Level of evidenceVI.Study typeEconomic/decision.
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Albert Farmer, T. "Trauma center organization and operation in academic health centers." American Journal of Emergency Medicine 3, no. 3 (May 1985): 244–46. http://dx.doi.org/10.1016/0735-6757(85)90098-1.

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23

SMITH, CATHY DEVITT, and JANET S. WEST. "Trauma injuries; classification of trauma centers; trauma patient care; clinical forensics." AORN Journal 60, no. 4 (October 1994): 604–6. http://dx.doi.org/10.1016/s0001-2092(07)63298-0.

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24

Horton, John D., Kent J. Dezee, and Michel Wagner. "Use of rFVIIa in the Trauma Setting–Practice Patterns in United States Trauma Centers." American Surgeon 74, no. 5 (May 2008): 413–17. http://dx.doi.org/10.1177/000313480807400510.

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Much excitement has been generated regarding the off label use of recombinant factor VIIa (rFVIIa) in the severely injured trauma patient. The purpose of our study is 3-fold: 1) describe the type of centers that use rFVIIa, 2) determine which centers use the drug more frequently, and finally 3) investigate how this drug is being administered at trauma centers. A survey was mailed or e-mailed to 435 trauma centers (Level I and II) throughout the nation. One hundred fifty-six surveys were returned. American College of Surgeons (ACS) verification and trauma Level I designation were independent predictors of rFVIIa use (odds ratio [OR] 3.74 and 5.40, P < 0.05). High users of rFVIIa were defined as those centers that had above median usage of the drug. Level I centers accounted for 67 per cent of the high users. Only the number of fellowship-trained trauma surgeons and trauma volume predicted high usage of rFVIIa (OR 1.38 and 14.09, P < 0.05). Trauma volume predicted whether or not Factor VII users implemented a protocol based approach to administration of the drug (OR 6.57, P < 0.05). Most protocols incorporated packed red blood cells (74%) before giving rFVIIa. The dose of 90 mcg/kg was exceeded in 34 per cent of centers, and 3 per cent used the 200 mcg/kg dose. High volume Level I trauma centers use rFVIIa more frequently and are more likely to use a systematic approach to its administration. However, there is no standardized approach to rFVIIa administration in United States trauma centers.
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Sheehan, Brian Matthew, Areg Grigorian, Shelley Maithel, Boris Borazjani, Roy M. Fujitani, Nii-Kabu Kabutey, Michael Lekawa, and Jeffry Nahmias. "Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers." Vascular and Endovascular Surgery 54, no. 8 (August 13, 2020): 692–96. http://dx.doi.org/10.1177/1538574420947234.

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Objectives: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. Methods: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. Results: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). Conclusion: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.
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Hakim, Ibrahim S., Christopher Newton, Matthew K. Schoen, Elizabeth A. Pirrotta, and Nancy E. Wang. "Nationwide Assessment of Factors Associated with Nonoperative Management of Pediatric Splenic Injury." American Surgeon 84, no. 5 (May 2018): 695–702. http://dx.doi.org/10.1177/000313481808400522.

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To evaluate variation in care nationwide for children with splenic injuries at pediatric trauma, adult trauma, and nontrauma centers. We used the National Inpatient Sample from 2001 to 2010 to identify pediatric patients with splenic injury. We analyzed demographic, clinical, and hospital status characteristics. The primary objective was comparison of splenectomy rates at pediatric, adult, and nontrauma centers. We identified 34,599 patients with splenic injury. Throughout the study, 3,979 (11.5%) patients underwent splenectomy: 8.2 per cent of patients at pediatric trauma, 17.6 per cent at adult trauma, and 14.5 per cent at nontrauma centers. Multivariate regression analysis demonstrated patients had decreased odds of splenectomy at pediatric trauma centers compared with adult and nontrauma centers (OR = 0.42, P < 0.001). In addition, children aged 14 to 17 years (OR = 2.5) with injury severity score > 14 (OR = 5.8) had increased odds of undergoing splenectomy. In this nationwide sample, children with splenic injury treated at adult trauma and nontrauma centers had significantly higher rates of splenectomy compared with children treated at pediatric trauma centers. We highlight the need for interventions that ensure all injured children receive appropriate and high quality trauma care.
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Wiebe, Douglas J., Daniel N. Holena, M. Kit Delgado, Nathan Mcwilliams, Juliet Altenburg, and Brendan G. Carr. "The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program." American Surgeon 83, no. 5 (May 2017): 445–52. http://dx.doi.org/10.1177/000313481708300516.

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Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance.
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Wagner, CCRP, Afton, Jordan Brewer, MPAS, PA-C, and Daniel Grabo, MD, FACS. "The Role of Advanced Practice Providers in the West Virginia Trauma System." West Virginia Medical Journal 117, no. 3 (September 1, 2021): 28–31. http://dx.doi.org/10.21885/wvmj.2021.20.

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BACKGROUND Injured patients in rural states like West Virginia (WV) rely on advanced practice providers (APPs) to provide initial care in Level Ill an IV trauma centers prior to transfer to medical centers with additional resources. This is a first attempt to survey trauma centers in WV and report on the roles that APPs perform in trauma care. METHODS Trauma directors and program managers at all 21 accredited trauma centers in WV were queried via an online survey. The number of APPs~-physicians' assistants (PAs) and nurse practitioners (NPs) participating in trauma care were queried from each center. Information was obtained on the location where APPs participated in trauma care, such as: trauma bay, operating room, and intensive care unit. Follow-up surveys inquired about trauma educational opportunities provided to APPs, including: Advanced Trauma Life Support (ATLS), Rural Trauma Team Development Course (RTTDC), and Stop the Bleed (STB). RESULTS Responses were received from 81% of WV's trauma centers. The total number of APPs participating in trauma care were 81 (PAS =48; NPS = 33). The majority of APPs performed patient care roles in the trauma bay (84%). The results of the follow-up survey demonstrated that 100% of trauma centers provide the ALS course for their APPs, 83% provide RTTDC, and 50% provide STB training. CONCLUSIONS The WV trauma system relies on APPs to deliver care from patient arrival through definitive treatment and disposition. Opportunities exist for education and training of the APP community within a rural trauma system.
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Garwe, Tabitha, Linda D. Cowan, Barbara Neas, Timothy Cathey, Brandon C. Danford, and Patrice Greenawalt. "Survival Benefit of Transfer to Tertiary Trauma Centers for Major Trauma Patients Initially Presenting to Nontertiary Trauma Centers." Academic Emergency Medicine 17, no. 11 (November 2010): 1223–32. http://dx.doi.org/10.1111/j.1553-2712.2010.00918.x.

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30

Spiegel, Thaís, and Daniel Bouzon Nagem Assad. "Operations Model for Trauma Centers." International Journal of Public Health Management and Ethics 3, no. 1 (January 2018): 1–13. http://dx.doi.org/10.4018/ijphme.2018010101.

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A relevant issue over the past few decades is the care of poly-trauma patients. The literature related to the care of patients suffering from poly-trauma, under the assistance point of view, is sufficiently consolidated concerning to the adoption of best practices. These are usually conducted and disseminated by accrediting organizations (for example, ACS). However, recent research and theoretical shortcomings brought some heterogeneous thoughts concerning operations management and design when trying to enlarge the literature beyond the assistential dimension. Therefore, after a review of the most important operations management and health bases, a conceptual model is proposed in this article which covers the relevant elements of an operation's projects such as: strategy, capacity, human resources, incentive systems, organizational structure and decision-making. This is in order to systematize the current stage of the field, highlighting the differences between recent studies and proposing a set of practices and premises which are necessary for the operationalization of the proposed model.
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Arthur, M. "Categorization of Rural Trauma Centers." Academic Emergency Medicine 11, no. 5 (May 1, 2004): 511. http://dx.doi.org/10.1197/j.aem.2004.02.487.

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32

Dries, D. J. "Complication Rates among Trauma Centers." Yearbook of Critical Care Medicine 2011 (January 2011): 245–47. http://dx.doi.org/10.1016/s0734-3299(10)79444-2.

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Harris, Burton H., and Larry J. Butler. "Teamwork in Pediatric Trauma Centers." Seminars in Pediatric Surgery 10, no. 1 (February 2001): 35–37. http://dx.doi.org/10.1053/spsu.2001.19392.

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34

Levanon, Talia. "Israel Trauma Coalition Resillience Centers." Prehospital and Disaster Medicine 25, S1 (February 2010): S52. http://dx.doi.org/10.1017/s1049023x00023049.

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Southard, Patricia. "Trauma centers: Novice to expert." Journal of Emergency Nursing 22, no. 6 (December 1996): 622–23. http://dx.doi.org/10.1016/s0099-1767(96)80232-7.

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Ang, Darwin N., Frederick P. Rivara, Avery Nathens, Gregory J. Jurkovich, Ronald V. Maier, Jin Wang, and Ellen J. MacKenzie. "Complication Rates among Trauma Centers." Journal of the American College of Surgeons 209, no. 5 (November 2009): 595–602. http://dx.doi.org/10.1016/j.jamcollsurg.2009.08.003.

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Mozingo, D. W. "Complication Rates among Trauma Centers." Yearbook of Surgery 2010 (January 2010): 30–31. http://dx.doi.org/10.1016/s0090-3671(10)79753-6.

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38

Knott, Victoria, and Ozan Akca. "Trauma Centers: A Quick Guide." Anesthesia & Analgesia 131, no. 3 (September 2020): e142-e142. http://dx.doi.org/10.1213/ane.0000000000004968.

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39

Miller, J. S. "Alcohol interventions in trauma centers." JAMA: The Journal of the American Medical Association 275, no. 5 (February 7, 1996): 358b—358. http://dx.doi.org/10.1001/jama.275.5.358b.

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Gitlitz, G. F. "Alcohol interventions in trauma centers." JAMA: The Journal of the American Medical Association 275, no. 5 (February 7, 1996): 358c—358. http://dx.doi.org/10.1001/jama.275.5.358c.

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Gentilello, Larry M. "Alcohol Interventions in Trauma Centers." JAMA 274, no. 13 (October 4, 1995): 1043. http://dx.doi.org/10.1001/jama.1995.03530130049027.

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42

Miller, Jean Somers. "Alcohol Interventions in Trauma Centers." JAMA: The Journal of the American Medical Association 275, no. 5 (February 7, 1996): 358. http://dx.doi.org/10.1001/jama.1996.03530290028017.

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43

Rostenberg, Peter O. "Alcohol Interventions in Trauma Centers." JAMA: The Journal of the American Medical Association 275, no. 5 (February 7, 1996): 358. http://dx.doi.org/10.1001/jama.1996.03530290028018.

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44

Gitlitz, George F. "Alcohol Interventions in Trauma Centers." JAMA: The Journal of the American Medical Association 275, no. 5 (February 7, 1996): 358. http://dx.doi.org/10.1001/jama.1996.03530290028019.

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45

Zitek, Tony, Kristina Pagano, Oren J. Mechanic, and David A. Farcy. "Assessment of Trauma Team Activation Fees by US Region and Hospital Ownership." JAMA Network Open 6, no. 1 (January 24, 2023): e2252520. http://dx.doi.org/10.1001/jamanetworkopen.2022.52520.

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ImportanceTrauma centers must be readily equipped to handle a variety of life-threatening injuries and consequently may charge a fee for the activation of their trauma team. Regional and hospital-related variations in trauma activation fees across the US have not been formally assessed.ObjectiveTo evaluate the variability of trauma activation fees from trauma centers across the US and examine whether certain hospital characteristics are associated with higher activation fees.Design, Setting, and ParticipantsThis cross-sectional study used data from the American College of Surgeons website to identify all trauma centers in the US that were listed as verified from inception of the verification database through March 4, 2022 (N = 546). Five military hospitals were excluded, and trauma activation fees could not be found for 18 trauma centers; the remaining 523 hospitals were included in the analysis. Each hospital’s publicly available chargemaster (a comprehensive list of a hospital’s products, procedures, and services) was searched to obtain its trauma activation fees. Two levels of trauma activation fees were recorded: tier 1 (full activation) and tier 2 (partial activation). Hospital-specific data were obtained from the American Hospital Association website. All data were collected between January 2 and March 11, 2022. Linear regression analyses were performed to assess potential associations between hospital characteristics (type of control [for profit, government, church, or other nonprofit], hospital system [owner], number of staffed beds, and academic vs nonacademic status) and trauma activation fees.Main Outcomes and MeasuresMedian and mean trauma activation fees nationally and stratified by location, hospital system, and other hospital characteristics.ResultsOf 523 trauma centers included in the analysis, most were located in the Midwest (180 centers) and West (129 centers). There were 176 adult level I trauma centers and 200 adult level II trauma centers; 69 centers had for-profit status, and 415 were academic. Overall, the median (IQR) tier 1 trauma activation fee was $9500 ($5601-$17 805), and the mean (SD) tier 1 trauma activation fee was $13 349 ($11 034); these fees ranged from $1000 to $61 734. Median (IQR) trauma activation fees were highest in the West ($18 099 [$10 741-$$27 607]), especially in California, where the median (IQR) activation fee was $24 057 ($15 979-$33 618). Trauma activation fees were also higher at for-profit hospitals, most of which were owned by the HCA Healthcare system, which had 43 trauma centers and a median (IQR) tier 1 trauma activation fee of $29 999 ($20 196-$37 589).Conclusions And RelevanceIn this study, trauma activation fees varied widely among hospitals in the US. Regional variation in these fees was substantial, with hospitals in the West charging substantially more than those in other locations. In addition, for-profit hospitals charged more than other types of hospitals. These findings suggest that some patients with serious traumatic injuries will incur disproportionately high trauma activation fees depending on the trauma center to which they are brought. Therefore, standardization of trauma activation fees is warranted.
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Chea, Heewon, and Hyun Kim. "Assessing trauma center accessibility in the Southeastern region of the U.S. to improve healthcare efficacy using an anti-covering approach." PLOS Global Public Health 3, no. 8 (August 18, 2023): e0002230. http://dx.doi.org/10.1371/journal.pgph.0002230.

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Accessibility to trauma centers is vital for the patients of severe motor vehicle crashes. Many vehicle crash fatalities failed to reach the proper emergency medical services since the accident location was far away from trauma centers. The spatial discordance between the service coverage area of trauma centers and actual locations of motor vehicle accidents delays the definitive medical care and results in death or disability. Many fatalities would have been prevented if the patients had a chance to get proper treatment in time at Southeastern region of the U.S. Also, the accessibility to trauma centers from the actual locations of motor vehicle accidents is different in the Southeastern region. This research aimed to facilitate the accessibility to trauma centers for severe motor vehicle crash patients in the Southeastern region. The analyses are conducted to assess current trauma center accessibility and suggest the optimal locations of future trauma centers using the Anti-covering location model for trauma centers (TraCt model). This study found that existing trauma centers failed to serve many demands, and the actual coverages of the current locations of trauma centers over potential demands are highly different in each Southeastern state. TraCt model is applied to each Southeastern state, and its solutions provide better coverage for demand locations. However, the TraCt model for each state tends to choose too many facilities, with excessively supplied facilities across the Southeastern region. The excessive service supply issue is addressed by applying the TraCt Model to a broader spatial extent. TraCt model applied to the entire Southeastern region and most of the demand, over 98% covered by the service coverage of optimal facility locations with 15 additional facilities. This research proves that the GIS and TraCt model applied to the broader spatial extent works well with increasing trauma medical service beneficiaries while providing a minimum number of additional facilities.
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Saucier, Jason A., Mary S. Dietrich, Cathy Maxwell, Meghan Brooks Lane-Fall, and Ann Minnick. "Trauma Patient Transitions From Critical Care: A Survey of U.S. Trauma Centers." Journal of Trauma Nursing 30, no. 6 (November 2023): 318–27. http://dx.doi.org/10.1097/jtn.0000000000000750.

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BACKGROUND: Transitions between clinical units are vulnerable periods for patients. A significant body of evidence describes the importance of structured transitions, but there is limited reporting of what happens. Describing transitions within a conceptual model will characterize the salient forces that interact during a patient transition and, perhaps, lead to improved outcomes. OBJECTIVE: To describe the processes and resources that trauma centers use to transition patients from critical care to nonintensive care units. METHODS: This cross-sectional study surveyed all Level I and II trauma centers listed in the American Trauma Society database from September 2020 to November 2020. Data were merged from the American Hospital Association 2018 Hospital Survey. RESULTS: A total of 567 surveys were distributed, of which 152 responded for a (27%) response rate. Results were organized in categories: capital input, organizational facets, employee behavior, employee terms/scope, and labor inputs. Resources and processes varied; the most important opportunities for transition improvement included: (1) handoff instruments were only reported at 36% (n = 27) of trauma centers, (2) mandatory resident education about transitions was only reported at 70% (n = 16) of trauma centers, and (3) only 6% (n = 4) of trauma centers reported electronic medical record applications that enact features to influence employee behavior. CONCLUSIONS: After years of focusing on transitions as a high-stake period, there remain many opportunities to develop resources and enact effective processes to address the variability in transition practice across trauma centers.
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Kaban, Jody M., Melvin E. Stone, Anand Dayama, Saman Safadjou, Srinivas H. Reddy, Ronald Simon, and Sheldon Teperman. "Does Resident Trauma Exposure Affect Advanced Trauma Operative Management Course Experience?" American Surgeon 82, no. 3 (March 2016): 212–15. http://dx.doi.org/10.1177/000313481608200313.

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The Advanced Trauma Operative Management (ATOM) course is a simulation course adopted by the American College of Surgeons to teach operative management of primarily penetrating, traumatic injuries. Although it is clear that overall operative trauma exposure is decreasing, the educational benefit of ATOM for residents with different amounts of trauma exposure remains unclear. Our aim was to determine whether residents from trauma centers experienced less benefit from the ATOM course when compared with residents from nontrauma centers. We compared two groups of residents who take ATOM through our institutional course, those from trauma centers and those from nontrauma centers. ATOM pre- and postcourse evaluations of knowledge and self-efficacy were collected from October 2007 to June 2013. Overall residents from three institutions, two trauma centers (100 residents) and one nontrauma center (34 residents), were included in the study. All resident groups had statistically significant improvement in knowledge and self-efficacy after taking the ATOM course ( P < 0.0001). There was no statistically significant difference in improvement relative to each of the groups in the ATOM categories of knowledge and self-efficacy. Our data show that residents with different levels of trauma exposure had similar pre- and postcourse scores as well as improvement in the ATOM evaluations. As operative trauma continues to decrease the ATOM course shows benefit for all residents regardless of the depth of their clinical trauma exposure in surgical residency.
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Ham, Kum S. "Trauma Patient Outcome Evaluation of Trauma and Nontrauma Centers." Prehospital and Disaster Medicine 16, S2 (September 2001): S121. http://dx.doi.org/10.1017/s1049023x00026303.

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50

Shrestha, R., SK Shrestha, SR Kayastha, N. Parajuli, D. Dhoju, and D. Shrestha. "A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area." Kathmandu University Medical Journal 11, no. 3 (May 3, 2015): 241–46. http://dx.doi.org/10.3126/kumj.v11i3.12513.

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Background Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. Objective This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Methods Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. Result In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Conclusion Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12513 Kathmandu Univ Med J 2013; 43(3):241-246
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