Do trauma centers improve outcome over non-trauma centers: the evaluation of regional trauma care using discharge abstract data and patient management categories.
Development of regional medical care systems to treat patients who sustain major accidental injuries (trauma victims) has been based on autopsy studies which demonstrate that hospitals that meet certain accepted criteria of readiness (trauma centers) can prevent needless deaths of trauma victims. However, since only autopsy data have been available from non-trauma centers, it has not previously been possible to compare morbidity data between trauma centers and non-trauma hospitals. This study examines discharge abstract data and a new patient classification system called patient management categories (PMC) which are generated from this abstract data to evaluate length of stay (LOS), complications, and death to compare morbidity and mortality data from trauma centers and non-trauma centers. Discharge abstracts for 1,332 patients with the PMC of femoral shaft fracture with operation were obtained from all hospitals in Western Pennsylvania and Maryland for 1 year. Data from trauma centers were identified and compared to non-trauma centers using the following criteria: time to OR (less than or equal to 2 days vs. greater than 2 days), age (0-12, 13-55, greater than 55 years), associated injuries, and development of complications and death. Patients treated in trauma centers had significantly fewer complications (21% vs. 33%; p less than 0.001) and lower mortality rates (p less than 0.05) than those treated in non-trauma centers. Associated injuries, age, complications, and/or delay in time to OR significantly increased intensity and length of stay in both trauma and non-trauma centers. This significantly increased the cost of care provided to these patients in both types of centers.(ABSTRACT TRUNCATED AT 250 WORDS)
Smith
J S
JS
Department of Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033.
Martin
L F
LF
Young
W W
WW
Macioce
D P
DP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005264:Femoral Fractures / Q000150:complications / Q000401:mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008396:Maryland; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010414:Pennsylvania; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality*