ATLS practices and survival at rural level III trauma hospitals, 1995-1999.
OBJECTIVE
To determine whether Advanced Trauma Life Support (ATLS) practices characterizing initial resuscitation and interfacility transfer at rural trauma hospitals are associated with risk-adjusted survival.


METHODS
Retrospective, observational analysis of rural injured patient survival. Process-of-care variables were associated with TRISS (trauma and injury severity score)-derived Z-statistics (95% confidence intervals) for high-risk population subsets (defined below).


METHODS
all patients > or = 12 years of age entered into a statewide trauma system, January 1, 1995, to December 31, 1999, and initially presenting to Level III trauma centers (N = 4,961).


METHODS
pronounced dead on arrival (n = 26), directly admitted to hospital (n = 3), and unknown disposition at first hospital (n = 2). Process variables include: intubation in emergency department (ED) given Glasgow Coma Scale (GCS) score < 9 [INTUB], administration of blood products in ED given systolic blood pressure (SBP) < 90 mm Hg [BLOOD], trauma surgeon presence within 5 minutes of patient arrival given GCS < 9 mm Hg or SBP < 90 mm Hg [UNSTABLE-TS], trauma surgeon presence within 5 minutes of patient arrival given injury severity score (ISS) > 15 [ISS-TS], transfer to higher level of care given ISS > 20 and no hypotension [TRAN], transfer to higher level of care given GCS < 9 [TRAN-GCS].


RESULTS
For the high-risk subpopulations, the following Z-scores (with and without an intervention) were found:


CONCLUSIONS
Some ATLS interventions (BLOOD, TRAN, and TRAN-GCS) are associated with improved survival for selected high-risk subgroups in these 21 rural Level III trauma hospitals.
Department of Emergency Medicine, Oregon Health & Science University, Portland 97201, USA.
Jerris R
JR
Hedges
Annette L
AL
Adams
Mary D
MD
Gunnels
D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods / Q000592:standards*; D000368:Aged; D002983:Clinical Competence; D004636:Emergency Service, Hospital / Q000592:standards* / Q000639:trends; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends*; D006780:Hospitals, Rural; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*