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Belinda J. Gabbe - One of the best experts on this subject based on the ideXlab platform.
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Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis.
World journal of surgery, 2017Co-Authors: Lynne Moore, Brice Lionel Batomen Kuimi, Howard R. Champion, Pier-alexandre Tardif, Gerard O'reilly, Ari Leppäniemi, Peter Cameron, Cameron S Palmer, Fikri M. Abu-zidan, Belinda J. GabbeAbstract:The effectiveness of Trauma Systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to Systematically review the evidence of the impact of Trauma System components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and Trauma association Web sites to identify studies evaluating the association between at least one Trauma System component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended Trauma System components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma System maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and Trauma System maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of Trauma Systems and non-fatal outcomes and explore the impact of System component interactions.
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Impact of Trauma System structure on injury outcomes: A Systematic review protocol
Systematic reviews, 2017Co-Authors: Lynne Moore, Howard R. Champion, Gerard O'reilly, Ari Leppäniemi, Peter Cameron, Cameron S Palmer, Fikri M. Abu-zidan, Belinda J. Gabbe, Christine Gaarder, Natalie L. YancharAbstract:Background Injury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of Trauma Systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of Trauma care varies significantly across Trauma Systems and we know little about which components of Trauma Systems contribute to their effectiveness. The objective of the study described in this protocol is to Systematically review evidence of the impact of Trauma System components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization.
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reduced population burden of road transport related major Trauma after introduction of an inclusive Trauma System
Annals of Surgery, 2015Co-Authors: Belinda J. Gabbe, Mark Fitzgerald, Rodney Judson, Ronan A Lyons, Jeff Richardson, Peter CameronAbstract:OBJECTIVE:: To describe the burden of road transport-related serious injury in Victoria, Australia, over a 10-year period, after the introduction of an integrated Trauma System. BACKGROUND:: Road traffic injury is a leading cause of death and disability worldwide. Efforts to improve care of the injured are important for reducing burden, but the impact of Trauma care Systems on burden and cost of road traffic injury has not been evaluated. METHODS:: All road transport-related deaths and major Trauma (injury severity score > 12) cases were extracted from population-based coroner and Trauma registry data sets for July 2001 to June 2011. Modeling was used to assess changes in population incidence rates and odds of in-hospital mortality. Disability-adjusted life years, combining years of life lost and years lived with disability, were calculated. Cost of health loss was calculated from estimates of the value of a disability-adjusted life year. RESULTS:: Incidence of road transport-related deaths decreased (incidence rate ratio 0.95, 95% confidence interval: 0.94-0.96), whereas the incidence of hospitalized major Trauma increased (incidence rate ratio 1.03, 95% confidence interval: 1.02-1.04). Years of life lost decreased by 43%, and years lived with disability increased by 32%, with an overall 28% reduction in disability-adjusted life years over the decade. There was a cost saving per case of A$633,446 in 2010-2011 compared with the 2001-2002 financial year. CONCLUSIONS:: Since introduction of the Trauma System in Victoria, Australia, the burden of road transport-related serious injury has decreased. Hospitalized major Trauma cases increased, whereas disability burden per case declined. Increased survival does not necessarily result in an overall increase in nonfatal injury burden.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Language: en
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patient perspectives of care in a regionalised Trauma System lessons from the victorian state Trauma System
The Medical Journal of Australia, 2013Co-Authors: Belinda J. Gabbe, Ann M Sutherland, Jude Sleney, Cameron Gosling, Krystle Patricia Wilson, Melissa J Hart, Nicola ChristieAbstract:OBJECTIVES To explore injured patients' experiences of Trauma care to identify areas for improvement in service delivery. DESIGN, SETTING AND PARTICIPANTS Qualitative study using in-depth, semi-structured interviews, conducted from 1 April 2011 to 31 January 2012, with 120 Trauma patients registered by the Victorian State Trauma Registry and the Victorian Orthopaedic Trauma Outcomes Registry and managed at the major adult Trauma services (MTS) in Victoria. MAIN OUTCOME MEASURES Emergent themes from patients' experiences of acute, rehabilitation and post-discharge care in the Victorian State Trauma System (VSTS). RESULTS Patients perceived their acute hospital care as high quality, although 3s with communication and surgical management delays were common. Discharge from hospital was perceived as stressful, and many felt ill prepared for discharge. A consistent emerging theme was the sense of a lack of coordination of post-discharge care, and the absence of a consistent point of contact for ongoing management. Most patients' primary point of contact after discharge was outpatient clinics at the MTS, which were widely criticised because of substantial delays in receiving an appointment, prolonged waiting times, limited time with clinicians, lack of continuity of care and inability to see senior clinicians. CONCLUSIONS This study highlights perceived 3s in the patient care pathway in the VSTS, especially those relating to communication, information provision and post-discharge care. Trauma patients perceived the need for a single point of contact for coordination of post-discharge care.
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paediatric and adolescent Trauma care within an integrated Trauma System
Injury-international Journal of The Care of The Injured, 2012Co-Authors: Cameron S Palmer, Belinda J. Gabbe, Conor Deasy, Franz E Babl, Catherine Bevan, Joe Crameri, Warwick Butt, Mark FitzgeraldAbstract:Abstract Background The aim of this study was to establish the profile and outcomes of paediatric major Trauma care (PTMC) within an integrated inclusive regionalised Trauma System. Methods Prospectively collected data from July 2001 to June 2009 from the Victorian State Trauma Registry of patients aged Results There were 1634 major Trauma cases with a median (IQR) age of 13 (6–16) years and 69% were male. The median ISS (IQR) was 18 (16–26). There were 1361 patients treated at a major Trauma centre of which 69% ( n = 943) were treated at the PMTC. Head injury (AIS > 2) was the most frequent injury ( n = 950, 58%). Surgery was required in 39% ( n = 637) of all cases; 437 patients in the 10–17 year old group and 200 patients in the 0–9 year old group; the mortality was 6.6%. There were 530 patients (32.4%) ventilated in ICU; these had a median ISS (IQR) of 25 (17–34) and mortality of 7.4%. Improvements in risk-adjusted mortality have occurred as the years have progressed [adjusted OR 95% CI: 0.87 (0.76, 0.99)] and being treated at a Level 1 Trauma centre was associated with lower adjusted odds of mortality [adjusted OR 95% CI: 0.27 (0.11, 0.68)]. Conclusion The establishment of this integrated inclusive regionalised Trauma System has been associated with progressively improving risk-adjusted mortality. The relatively low volume of major Trauma requiring surgery in the 0–9 year old age group is notable, creating a challenging environment for maintaining skills and institutional preparedness.
Peter Cameron - One of the best experts on this subject based on the ideXlab platform.
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Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis.
World journal of surgery, 2017Co-Authors: Lynne Moore, Brice Lionel Batomen Kuimi, Howard R. Champion, Pier-alexandre Tardif, Gerard O'reilly, Ari Leppäniemi, Peter Cameron, Cameron S Palmer, Fikri M. Abu-zidan, Belinda J. GabbeAbstract:The effectiveness of Trauma Systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to Systematically review the evidence of the impact of Trauma System components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and Trauma association Web sites to identify studies evaluating the association between at least one Trauma System component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended Trauma System components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma System maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and Trauma System maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of Trauma Systems and non-fatal outcomes and explore the impact of System component interactions.
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Impact of Trauma System structure on injury outcomes: A Systematic review protocol
Systematic reviews, 2017Co-Authors: Lynne Moore, Howard R. Champion, Gerard O'reilly, Ari Leppäniemi, Peter Cameron, Cameron S Palmer, Fikri M. Abu-zidan, Belinda J. Gabbe, Christine Gaarder, Natalie L. YancharAbstract:Background Injury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of Trauma Systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of Trauma care varies significantly across Trauma Systems and we know little about which components of Trauma Systems contribute to their effectiveness. The objective of the study described in this protocol is to Systematically review evidence of the impact of Trauma System components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization.
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reduced population burden of road transport related major Trauma after introduction of an inclusive Trauma System
Annals of Surgery, 2015Co-Authors: Belinda J. Gabbe, Mark Fitzgerald, Rodney Judson, Ronan A Lyons, Jeff Richardson, Peter CameronAbstract:OBJECTIVE:: To describe the burden of road transport-related serious injury in Victoria, Australia, over a 10-year period, after the introduction of an integrated Trauma System. BACKGROUND:: Road traffic injury is a leading cause of death and disability worldwide. Efforts to improve care of the injured are important for reducing burden, but the impact of Trauma care Systems on burden and cost of road traffic injury has not been evaluated. METHODS:: All road transport-related deaths and major Trauma (injury severity score > 12) cases were extracted from population-based coroner and Trauma registry data sets for July 2001 to June 2011. Modeling was used to assess changes in population incidence rates and odds of in-hospital mortality. Disability-adjusted life years, combining years of life lost and years lived with disability, were calculated. Cost of health loss was calculated from estimates of the value of a disability-adjusted life year. RESULTS:: Incidence of road transport-related deaths decreased (incidence rate ratio 0.95, 95% confidence interval: 0.94-0.96), whereas the incidence of hospitalized major Trauma increased (incidence rate ratio 1.03, 95% confidence interval: 1.02-1.04). Years of life lost decreased by 43%, and years lived with disability increased by 32%, with an overall 28% reduction in disability-adjusted life years over the decade. There was a cost saving per case of A$633,446 in 2010-2011 compared with the 2001-2002 financial year. CONCLUSIONS:: Since introduction of the Trauma System in Victoria, Australia, the burden of road transport-related serious injury has decreased. Hospitalized major Trauma cases increased, whereas disability burden per case declined. Increased survival does not necessarily result in an overall increase in nonfatal injury burden.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Language: en
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improved functional outcomes for major Trauma patients in a regionalized inclusive Trauma System
Annals of Surgery, 2012Co-Authors: Belinda J. Gabbe, Mark Fitzgerald, Pamela May Simpson, Ann M Sutherland, Rory Wolfe, Rodney Judson, Peter CameronAbstract:Objective:To describe outcomes of major Trauma survivors managed in an organized Trauma System, including the association between levels of care and outcomes over time.Background:Trauma care Systems aim to reduce deaths and disability. Studies have found that regionalization of Trauma care reduces m
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the effect of an organized Trauma System on mortality in major Trauma involving serious head injury a comparison of the united kingdom and victoria australia
Annals of Surgery, 2011Co-Authors: Belinda J. Gabbe, Fiona Lecky, Grad Dip Biostat, Omar Bouamra, M Woodford, Tom Jenks, Timothy J Coats, Peter CameronAbstract:OBJECTIVE:: To compare outcomes following major Trauma involving serious head injury managed in an inclusive Trauma System (Victoria, Australia) and a setting where rationalization of Trauma services is absent (England/Wales). BACKGROUND:: The introduction of regionalized Trauma Systems has the potential to reduce preventable deaths, but their uptake has been slow around the world. Improved understanding of the benefits and limitations of different Systems of Trauma care requires comparison across Systems. METHODS:: Mortality outcomes following major Trauma involving serious head injury managed in the 2 settings were compared using multivariate logistic regression. Data pertaining to the period July 2001 to June 2006 (inclusive) were extracted from the Trauma Audit and Research Network (TARN) in the United Kingdom and the Victorian State Trauma Registry (VSTR) in Australia. RESULTS:: A total of 4064 (VSTR) and 6024 (TARN) cases were provided for analysis. The odds of death for TARN cases were significantly higher than those for VSTR cases [odds ratio = 2.15, 95% confidence interval = 1.95-2.37]. After adjusting for age, gender, cause of injury, head injury severity, Glasgow Coma Scale score, and Injury Severity Score, TARN cases remained at elevated odds of death (3.22; 95% confidence interval = 2.84-3.65) compared with VSTR cases. CONCLUSIONS:: Management of the severely injured patient with an associated head injury in England and Wales, where an organized Trauma System is absent, was associated with increased risk-adjusted mortality compared with management of these patients in the inclusive Trauma System of Victoria, Australia. This study provides further evidence to support efforts to implement such Systems. Language: en
Lynne Moore - One of the best experts on this subject based on the ideXlab platform.
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Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis.
World journal of surgery, 2017Co-Authors: Lynne Moore, Brice Lionel Batomen Kuimi, Howard R. Champion, Pier-alexandre Tardif, Gerard O'reilly, Ari Leppäniemi, Peter Cameron, Cameron S Palmer, Fikri M. Abu-zidan, Belinda J. GabbeAbstract:The effectiveness of Trauma Systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to Systematically review the evidence of the impact of Trauma System components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and Trauma association Web sites to identify studies evaluating the association between at least one Trauma System component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended Trauma System components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma System maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and Trauma System maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of Trauma Systems and non-fatal outcomes and explore the impact of System component interactions.
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Impact of Trauma System structure on injury outcomes: A Systematic review protocol
Systematic reviews, 2017Co-Authors: Lynne Moore, Howard R. Champion, Gerard O'reilly, Ari Leppäniemi, Peter Cameron, Cameron S Palmer, Fikri M. Abu-zidan, Belinda J. Gabbe, Christine Gaarder, Natalie L. YancharAbstract:Background Injury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of Trauma Systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of Trauma care varies significantly across Trauma Systems and we know little about which components of Trauma Systems contribute to their effectiveness. The objective of the study described in this protocol is to Systematically review evidence of the impact of Trauma System components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization.
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Influence of access to an integrated Trauma System on in-hospital mortality and length of stay
Injury, 2015Co-Authors: Brice Lionel Batomen Kuimi, Lynne Moore, Brahim Cisse, Mathieu Gagné, André Lavoie, Gilles Bourgeois, Jean LapointeAbstract:Abstract Background Few data are available on population-based access to specialised Trauma care and its influence on patient outcomes in an integrated Trauma System. We aimed to evaluate the influence of access to an integrate Trauma System on in-hospital mortality and length of stay (LOS). Methods All adults admitted to acute care hospitals for major Trauma [International Classification of Diseases Injury Severity Score (ICISS Results We identified 22,749 injury admissions. In-hospital mortality was 7% and median LOS was 9 days for all injuries. Overall, 92% of patients were treated within the Trauma System. Globally, patients who did not have access had similar mortality and LOS compared to patients who had access. However, we observed a 62% reduction in mortality for critical abdominal/thoracic injuries (odds ratio = 0.38; 95% CI, 0.16–0.92) and an 8% increase in LOS for TBI patients (geometric mean ratio = 1.08; 95% CI, 1.02–1.14) treated within the Trauma System. Conclusions Results provides evidence that in a health System with an integrated mature Trauma System, access to specialised Trauma care is high and the small proportion of patients treated outside the System, have similar mortality and LOS compared to patients treated within the System. This study suggests that the Quebec Trauma System performs well in its mandate to offer appropriate treatment to victims of injury that require specialised care.
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Evaluation of the long-term trend in mortality from injury in a mature inclusive Trauma System.
World journal of surgery, 2010Co-Authors: Lynne Moore, James A. Hanley, Alexis F. Turgeon, André LavoieAbstract:Background Organized Trauma Systems are designed to improve the quality and efficiency of Trauma care. Several studies have reported mortality reductions during or immediately after implementation of a Trauma System but little data are available on long-term trends. The aim of this study was to evaluate the long-term trend in risk-adjusted mortality in a mature inclusive Trauma System.
David J. Ciesla - One of the best experts on this subject based on the ideXlab platform.
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the Trauma ecoSystem the impact and economics of new Trauma centers on a mature statewide Trauma System
Journal of Trauma-injury Infection and Critical Care, 2017Co-Authors: David J. Ciesla, Etienne E. Pracht, Pablo T Leitz, David A Spain, Kristan Staudenmayer, Joseph J. TepasAbstract:Introduction Florida serves as a model for the study of Trauma System performance. Between 2010 and 2104, 5 new Trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of Trauma System expansion on System triage performance and Trauma center patients' profiles. Methods A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its Trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) Trauma centers and new E2 (N2) centers. Results Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall Trauma System triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Conclusion Designation of new Trauma centers in a mature System was associated with a change in established Trauma center demographics and economics without an improvement in Trauma System triage performance. These findings suggest that the health of an entire Trauma System network must be considered in the design and implementation of a regional Trauma System. Level of evidence Therapeutic/care management study, level IV; epidemiological, level IV.
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Measuring Trauma System performance: right patient, right place-mission accomplished?
Journal of Trauma and Acute Care Surgery, 2015Co-Authors: David J. Ciesla, Etienne E. Pracht, Joseph J. Tepas, Nicholas Namias, Frederick A. Moore, John Y. Cha, Andrew J. Kerwin, Barbara Langland-orbanAbstract:BACKGROUND: A regional Trauma System must establish and monitor acceptable overtriage and undertriage rates. Although diagnoses from discharge data sets can be used with mortality prediction models to define high-risk injury, retrospective analyses introduce methodological errors when evaluating real-time triage processes. The purpose of this study was to determine if major Trauma patients identified using field criteria correlated with those retrospectively labeled high risk and to assess System performance by measuring triage accuracy and Trauma center utilization. METHODS: A statewide database was queried for all injury-related International Classification of Diseases, 9th Revision, code discharges from designated Trauma centers and nonTrauma centers for 2012. Children and burn patients were excluded. Patients assigned a Trauma alert fee were considered field-triage(+). The International Classification Injury Severity Score methodology was used to estimate injury-related survival probabilities, with an International Classification Injury Severity Score less than 0.85 considered high risk. Triage rates were expressed relative to the total population; the proportion of low- and high-risk patients discharged from Trauma centers defined Trauma center utilization. RESULTS: There were 116,990 patients who met study criteria, including 11,368 (10%) high-risk, 70,741 field-triage(-) patients treated in nonTrauma centers and 28,548 field-triage(-) and 17,791 field-triage(+) patients treated in Trauma centers. Field triage was 86% accurate, with 10% overtriage and 4% undertriage. System triage was 66% accurate, with 32% overtriage and 2% undertriage. Overtriage patients more often, and undertriage patients less often, had severe injury characteristics than appropriately triaged patients. CONCLUSION: Trauma System performance assessed using retrospective administrative data provides a convenient measure of performance but must be used with caution. Residual mistriage can partly be attributed to error introduced by retrospective high-risk definitions, whereas differences between field and System triage accuracy can be attributed to the Trauma center's role as a large community hospital. Given the limitations of the data and methods, these results may represent optimal patient distribution within this mature System. Language: en
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fifteen year Trauma System performance analysis demonstrates optimal coverage for most severely injured patients and identifies a vulnerable population
Journal of The American College of Surgeons, 2013Co-Authors: David J. Ciesla, Etienne E. Pracht, Joseph J. Tepas, John Y. Cha, Barbara Langlandorban, Lewis M FlintAbstract:Background Trauma Systems are designed to deliver timely and appropriate care. Prehospital triage regulations and interfacility transfer guidelines are the primary determinants of System efficacy. We analyzed the effectiveness of the Florida Trauma System in delivering Trauma patients to Trauma centers over time. Study Design Injured patients were identified by ICD-9 codes from a statewide discharge dataset, and they were categorized as children (less than 16 years old), adult (16 to 65 years old), or elderly (over 65 years old). Severe injury was defined by International Classification Injury Severity Scores (ICISS) Results Severe injury discharges increased at designated Trauma centers (DTCs) and decreased at nonTrauma centers (NTCs). The proportion of patients with severe injuries discharged from DTCs increased for all age groups, capturing nearly all severely injured children and adults. Access to DTCs was dependent on proximity for severely injured elderly but not for severely injured children and adults. Conclusions Triage improved over time, enabling near complete capture of at-risk children and adults independent of DTC proximity. Because distance from a DTC does not limit access for children and adults, existing Trauma System resources are sufficient to meet the current demands. Efforts are needed to determine the Trauma resource and triage needs of the severely injured elderly.
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Secondary overtriage: a consequence of an immature Trauma System.
Journal of the American College of Surgeons, 2007Co-Authors: David J. Ciesla, Jack Sava, James H. Street, Marion H. JordanAbstract:Background Trauma Systems are designed to bring the injured patient to definitive care in the shortest practical time. This depends on prehospital destination criteria (primary triage) and interfacility transfer guidelines (secondary triage). Although primary undertriage is associated with increased costs and worse outcomes for selected injuries, secondary overtriage can overwhelm System resources and delay definitive care. The purpose of this study was to determine the incidence of secondary overtriage in a region without a formal Trauma System. Study Design Retrospective cohort study of Trauma registry data at an American College of Surgeons Committee on Trauma−verified Level I Trauma center and regional referral center. Secondary overtriage was defined as patients transferred from another hospital emergency department to our Trauma receiving unit who had an injury severity score Results Data on 9,064 patients were reviewed; 6,875 (76%) arrived directly from the scene and 2,189 (24%) were transferred. Although the transferred group was more severely injured, the majority (64%) had minor injuries and 824 (39%) met secondary overtriage criteria. The degree of secondary overtriage and injury pattern varied with respect to referring facility. Peak admission day and times for overtriage patients coincided with scene admissions Trauma receiving unit closure events. Patient payor mix and facility cost and reimbursement profiles did not differ between scene and transfer overtriage patients. Conclusions A substantial proportion of transferred Trauma patients require only brief diagnostic or observational care. Excessive overtriage calls for development of a regional inclusive Trauma System with established primary and secondary triage guidelines to improve access to care and Trauma System efficiency.
Mark Fitzgerald - One of the best experts on this subject based on the ideXlab platform.
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reduced population burden of road transport related major Trauma after introduction of an inclusive Trauma System
Annals of Surgery, 2015Co-Authors: Belinda J. Gabbe, Mark Fitzgerald, Rodney Judson, Ronan A Lyons, Jeff Richardson, Peter CameronAbstract:OBJECTIVE:: To describe the burden of road transport-related serious injury in Victoria, Australia, over a 10-year period, after the introduction of an integrated Trauma System. BACKGROUND:: Road traffic injury is a leading cause of death and disability worldwide. Efforts to improve care of the injured are important for reducing burden, but the impact of Trauma care Systems on burden and cost of road traffic injury has not been evaluated. METHODS:: All road transport-related deaths and major Trauma (injury severity score > 12) cases were extracted from population-based coroner and Trauma registry data sets for July 2001 to June 2011. Modeling was used to assess changes in population incidence rates and odds of in-hospital mortality. Disability-adjusted life years, combining years of life lost and years lived with disability, were calculated. Cost of health loss was calculated from estimates of the value of a disability-adjusted life year. RESULTS:: Incidence of road transport-related deaths decreased (incidence rate ratio 0.95, 95% confidence interval: 0.94-0.96), whereas the incidence of hospitalized major Trauma increased (incidence rate ratio 1.03, 95% confidence interval: 1.02-1.04). Years of life lost decreased by 43%, and years lived with disability increased by 32%, with an overall 28% reduction in disability-adjusted life years over the decade. There was a cost saving per case of A$633,446 in 2010-2011 compared with the 2001-2002 financial year. CONCLUSIONS:: Since introduction of the Trauma System in Victoria, Australia, the burden of road transport-related serious injury has decreased. Hospitalized major Trauma cases increased, whereas disability burden per case declined. Increased survival does not necessarily result in an overall increase in nonfatal injury burden.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Language: en
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paediatric and adolescent Trauma care within an integrated Trauma System
Injury-international Journal of The Care of The Injured, 2012Co-Authors: Cameron S Palmer, Belinda J. Gabbe, Conor Deasy, Franz E Babl, Catherine Bevan, Joe Crameri, Warwick Butt, Mark FitzgeraldAbstract:Abstract Background The aim of this study was to establish the profile and outcomes of paediatric major Trauma care (PTMC) within an integrated inclusive regionalised Trauma System. Methods Prospectively collected data from July 2001 to June 2009 from the Victorian State Trauma Registry of patients aged Results There were 1634 major Trauma cases with a median (IQR) age of 13 (6–16) years and 69% were male. The median ISS (IQR) was 18 (16–26). There were 1361 patients treated at a major Trauma centre of which 69% ( n = 943) were treated at the PMTC. Head injury (AIS > 2) was the most frequent injury ( n = 950, 58%). Surgery was required in 39% ( n = 637) of all cases; 437 patients in the 10–17 year old group and 200 patients in the 0–9 year old group; the mortality was 6.6%. There were 530 patients (32.4%) ventilated in ICU; these had a median ISS (IQR) of 25 (17–34) and mortality of 7.4%. Improvements in risk-adjusted mortality have occurred as the years have progressed [adjusted OR 95% CI: 0.87 (0.76, 0.99)] and being treated at a Level 1 Trauma centre was associated with lower adjusted odds of mortality [adjusted OR 95% CI: 0.27 (0.11, 0.68)]. Conclusion The establishment of this integrated inclusive regionalised Trauma System has been associated with progressively improving risk-adjusted mortality. The relatively low volume of major Trauma requiring surgery in the 0–9 year old age group is notable, creating a challenging environment for maintaining skills and institutional preparedness.
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improved functional outcomes for major Trauma patients in a regionalized inclusive Trauma System
Annals of Surgery, 2012Co-Authors: Belinda J. Gabbe, Mark Fitzgerald, Pamela May Simpson, Ann M Sutherland, Rory Wolfe, Rodney Judson, Peter CameronAbstract:Objective:To describe outcomes of major Trauma survivors managed in an organized Trauma System, including the association between levels of care and outcomes over time.Background:Trauma care Systems aim to reduce deaths and disability. Studies have found that regionalization of Trauma care reduces m
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the evolution of an integrated state Trauma System in victoria australia
Injury-international Journal of The Care of The Injured, 2005Co-Authors: Christopher Atkin, Ilan Freedman, Jeffrey V Rosenfeld, Mark Fitzgerald, Thomas KossmannAbstract:Summary The incidence of major Trauma and associated fatalities in the State of Victoria, Australia, have declined over 20 years following the successful implementation of strategies to modify environmental and behavioural factors that contribute to motor vehicle injuries. However, several System deficiencies in the management of major Trauma patients had remained unresolved. To investigate these shortfalls the State Government of Victoria established a taskforce in 1997 to review Trauma and emergency services. The taskforce adopted the principle of “the right patient to the right hospital in the shortest time” and in 2000 began to deploy an integrated State Trauma System. Implementation of such a System required the designation of specific hospitals of various levels to care for Trauma patients; the concentration of Trauma expertise at these centres; integration and coordination between the service providers; development of agreed triage and transfer protocols and improved education, training and research programs. A statewide major Trauma database was established to enable System monitoring and facilitate further enhancements. The Victorian experience with the development of an integrated Trauma System should aid in the development of similar Systems nationally and internationally and is described in this paper.
