title: The changing face of trauma: New Orleans before and after Hurricane Katrina.
abstract: Charity Hospital (CH) was devastated by Hurricane Katrina and remains closed. Design and staffing of a new, temporary dedicated trauma hospital relied on data from prior experience at CH, updated census information, and a changed trauma demographic. The study objective was to analyze the new trauma program and evaluate changes in demographics, injury patterns, and outcomes between pre- (PK) and post-Katrina (POK) trauma populations. A retrospective review of trauma patients' demographics, anatomical variables, and physiological variables 6 months PK and POK was performed under an approved Institutional Review Board protocol. Trauma activation triage criteria between study periods were also analyzed. Continuous data comparisons between the two time periods were made with Student's t test. Dichotomous data were analyzed using chi2 test. The demographic of trauma patients is different in the POK interval, reflecting changes in the New Orleans population. Modification of triage criteria by the exclusion of mechanism as an activation criterion resulted in an increase of patients with higher acuity and Injury Severity Score, lower initial Glasgow Coma Score, and a higher proportion of penetrating mechanism. Outcome measures reflect longer length of stay (4.4 vs. 6.8 days, P < 0.0001) without a significant difference in mortality (6.0 vs 7.5, P = 0.227). Hospital data demonstrates that the POK trauma system was stressed by the increased acuity, penetrating injury, and number of procedures per patient (1.7 vs. 3.4). Resources should be directed toward patients requiring multidisciplinary care by increasing intensive care unit beds and operating room capacity. Future resource planning in the recovery phases of large-scale natural disasters should take into account these observations.
authors.affiliation: Tulane School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Georgia M
authors.initials: GM
authors.lastname: Wahl
authors.forename: Alan B
authors.initials: AB
authors.lastname: Marr
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Brevard
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Weintraub
authors.forename: John P
authors.initials: JP
authors.lastname: Hunt
authors.forename: Norman E
authors.initials: NE
authors.lastname: McSwain
authors.forename: Juan C
authors.initials: JC
authors.lastname: Duchesne
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Baker
mesh_terms: D000328:Adult; D055867:Cyclonic Storms; D003695:Delivery of Health Care / Q000379:methods / Q000639:trends*; D004190:Disasters; D005006:Ethnicity; D005151:Facial Injuries / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D010343:Patient Admission / Q000639:trends*; D012189:Retrospective Studies; D015599:Trauma Severity Indices