Establishing the need for trauma center care

Anatomic injury or resource use?

Craig Newgard, Jerris R. Hedges, Brian Diggs, Richard Mullins

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective. It remains unclear whether the "need" for care at a trauma center should be based on anatomic injury (the current standard) or specialized resource use. We investigated whether anatomic injury severity scores adequately explain hospital resource use. Methods. This was a retrospective cohort study including children and adults meeting statewide trauma criteria and transported to 48 hospitals from 1998 to 2003. The injury severity score (ISS) was considered as both continuous (range 0-75) and categorical (0-8, 9-15, and ≥ 16) terms. Specialized resource use was defined as: major surgery (with and without orthopedic intervention), mechanical ventilation > 96 hours, blood transfusion, intensive care unit (ICU) stay ≥ 2 days, or in-hospital mortality. Resource use was assessed as both a binary variable and a continuous term. Descriptive statistics and simple and multivariable linear regressions were used to compare ISS and resource use. Results. 33,699 injured persons were included in the analysis. Within mild, moderate, and serious anatomic injury categories, 8%, 26%, and 69%, respectively, had specialized resource use. When the resource use definition included orthopedic surgery, 12%, 49%, and 76%, respectively, had specialized resource use. Whereas there was fair correlation between ISS and additive resource use (rho = 0.61), ISS explained only 37% of the variability in resource use (adjusted R-squared = 0.37). Resource use within anatomic injury categories differed by age group. Conclusions. The standard anatomic injury criterion for trauma center "need" (i.e., ISS ≥ 16) misclassifies a substantial number of injured persons requiring critical trauma resources. Out-of-hospital trauma triage guidelines based on anatomic injury may need revision to account for patients with resource need.

Original languageEnglish (US)
Pages (from-to)451-458
Number of pages8
JournalPrehospital Emergency Care
Volume12
Issue number4
DOIs
StatePublished - Sep 2008

Fingerprint

Trauma Centers
Injury Severity Score
Wounds and Injuries
Orthopedics
Triage
Hospital Mortality
Artificial Respiration
Blood Transfusion
Intensive Care Units
Linear Models
Cohort Studies
Retrospective Studies
Age Groups
Guidelines

Keywords

  • Anatomic injury
  • Injury severity scores
  • Resource use
  • Trauma center need
  • Triage

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Establishing the need for trauma center care : Anatomic injury or resource use? / Newgard, Craig; Hedges, Jerris R.; Diggs, Brian; Mullins, Richard.

In: Prehospital Emergency Care, Vol. 12, No. 4, 09.2008, p. 451-458.

Research output: Contribution to journalArticle

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abstract = "Objective. It remains unclear whether the {"}need{"} for care at a trauma center should be based on anatomic injury (the current standard) or specialized resource use. We investigated whether anatomic injury severity scores adequately explain hospital resource use. Methods. This was a retrospective cohort study including children and adults meeting statewide trauma criteria and transported to 48 hospitals from 1998 to 2003. The injury severity score (ISS) was considered as both continuous (range 0-75) and categorical (0-8, 9-15, and ≥ 16) terms. Specialized resource use was defined as: major surgery (with and without orthopedic intervention), mechanical ventilation > 96 hours, blood transfusion, intensive care unit (ICU) stay ≥ 2 days, or in-hospital mortality. Resource use was assessed as both a binary variable and a continuous term. Descriptive statistics and simple and multivariable linear regressions were used to compare ISS and resource use. Results. 33,699 injured persons were included in the analysis. Within mild, moderate, and serious anatomic injury categories, 8{\%}, 26{\%}, and 69{\%}, respectively, had specialized resource use. When the resource use definition included orthopedic surgery, 12{\%}, 49{\%}, and 76{\%}, respectively, had specialized resource use. Whereas there was fair correlation between ISS and additive resource use (rho = 0.61), ISS explained only 37{\%} of the variability in resource use (adjusted R-squared = 0.37). Resource use within anatomic injury categories differed by age group. Conclusions. The standard anatomic injury criterion for trauma center {"}need{"} (i.e., ISS ≥ 16) misclassifies a substantial number of injured persons requiring critical trauma resources. Out-of-hospital trauma triage guidelines based on anatomic injury may need revision to account for patients with resource need.",
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