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10-06-2012 | Article

Trauma center triage boosts odds of surviving car crashes

Abstract

Journal

MedWire News: People who are seriously injured in a motor vehicle accident have a 30% greater chance for surviving for a minimum of 48 hours if they are triaged directly to a Level I or Level II trauma center than if they are transported first to a facility without specialty trauma services, Canadian investigators report.

Accident victims transported directly to a trauma center had a significantly lower risk for death than victims triaged to non-trauma centers at both 24 hours (odds ratio [OR]=0.58) and 48 hours (OR=0.68), report Barbara Haas (University of Toronto, Ontario, Canada) and colleagues.

There were also trends, albeit nonsignificant, toward better 7- and 30-day survival among patients triaged directly to trauma centers, the authors report in the June issue of The Journal of Trauma and Acute Care Surgery.

The findings underscore the importance of having adequate emergency medical transport systems in place, and for training emergency medical technicians, paramedics, and emergency department personnel to recognize when trauma patients need the urgent services of specialty trauma center, according to co-author Avery Nathens (St Michael's Hospital, Toronto).

"Minutes matter and severely injured patients can't advocate for themselves so we have the responsibility to ensure that the system works optimally," he said in a statement.

The investigators conducted a retrospective population-based cohort of trauma-care effectiveness in cities, suburbs, and rural areas throughout Ontario, Canada's most populous province. They drew on databases containing information on emergency department deaths and admissions throughout the study area, focusing on adults in motor vehicle accidents from 2002 through 2010. They limited the dataset to patients with severe injury scores, defined as an Injury Severity Score >15, or death with 24 hours of emergency department presentation.

A total of 6341 patients met study criteria for the specified period. Of these, 2857 (45%) were taken directly from the accident scene to a trauma center, and 3484 were taken to a non-trauma hospital. Of the latter group, 2003 (57%) were later transferred to a trauma center.

A total of 761 patients in the entire cohort died (crude mortality rate, 12%). Although there were no significant differences in the crude mortality rates among the different facility types at any time point in the study, the number of deaths was more than twice as high in non-trauma emergency departments (158 patients) than in trauma centers (64 patients), the authors found.

The authors note that the lack of a survival benefit for trauma centers after 48 hours may be related to differences in care beyond the first critical days of trauma care.

"Less specific guidance is provided regarding the resources required to care for patients who survive initial resuscitation and care. As such, although early [trauma center] care is likely to be relatively homogeneous across [trauma centers], care provided after initial stabilization may be more heterogeneous."

By Neil Osterweil