The Impact of a Dedicated Trauma Program on Outcome in Severely Injured Patients

D. Demetriades, MD, PhD; T. V. Berne, MD; H. Belzberg, MD; J. Asensio, MD; E. Cornwell, MD; W. Dougherty, MD; K. Alo, RN; T. R. DeMeester, MD
Arch Surg. 1995;130(2):216-220. doi:10.1001/archsurg.1995.01430020106020.
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Background:  In recent years, many trauma centers have been closing or scaling down their operations because of financial losses and lack of commitment by the relevant authorities.

Objective:  To investigate the effect of commitment to trauma and the establishment of a dedicated trauma program on injury outcome.

Design:  In 1992, a well-funded dedicated trauma program was implemented at the Los Angeles County—University of Southern California Medical Center, Los Angeles. We analyzed the outcome in severely injured patients (Injury Severity Score [ISS] > 15) before and after implementation of the program (1991 and 1993).

Setting:  Large, urban, level 1 trauma center.

Patients:  Patients with trauma and an ISS higher than 15.

Results:  There were 737 patients with an ISS higher than 15 in 1991 and 812 patients with an ISS higher than 15 in 1993. The overall mortality rate was 30% in 1991 and 24.5% in 1993 (P=.018), which is a reduction by 18.3%. In patients with blunt trauma and an ISS higher than 15, mortality was reduced by 33% (mortality rate of 31.1% in 1991 vs 20.8% in 1993) (P<.002). Mortality in patients with penetrating trauma and an ISS higher than 30 was reduced by 42.7% (mortality rate of 59.3% in 1991 vs 34% in 1993) (P=.019). There was also a trend toward lower permanent disabilities among survivors with an ISS higher than 15 (14.7% in 1991 vs 11.3% in 1993).

Conclusion:  Commitment of financial and human resources for the establishment of a dedicated trauma program is a sound investment in terms of improved survival and fewer permanent disabilities in critically injured patients.(Arch Surg. 1995;130:216-220)


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