Trauma system overtriage: are we on track?

The American College of Surgeons (ACS) recommends trauma overtriage rate (OT) below 50 per cent to maximize efficiency while ensuring optimal care. This retrospective study was undertaken to evaluate OT rates in our Level I trauma center using the most recent criteria and guidelines. OT rates during a 12-month period were measured using six definitions based on combinations of Injury Severity Score (ISS), length of hospital stay (LOS, in days), procedures, and disposition after the emergency department.

A comparison of rural versus urban trauma care.

Objective: We compared the survival of trauma patients in urban versus rural settings after the implementation of a novel rural non-trauma center alternative care model called the Model Rural Trauma Project (MRTP).

Materials And Methods: We conducted an observational cohort study of all trauma patients brought to eight rural northern California hospitals and two southern California urban trauma centers over a one-year period (1995-1996). Trauma patients with an injury severity score (ISS) of >10 were included in the study.

Selective use of computed tomography compared with routine whole body imaging in patients with blunt trauma.

Study Objective: Routine pan-computed tomography (CT, including of the head, neck, chest, abdomen/pelvis) has been advocated for evaluation of patients with blunt trauma based on the belief that early detection of clinically occult injuries will improve outcomes. We sought to determine whether selective imaging could decrease scan use without missing clinically important injuries.

Methods: This was a prospective observational study of 701 patients with blunt trauma at an academic trauma center.

Hips can lie: impact of excluding isolated hip fractures on external benchmarking of trauma center performance.

Background: Trauma centers (TCs) vary in the inclusion of patients with isolated hip fractures (IHFs) in their registries. This inconsistent case ascertainment may have significant implications on the assessment of TC performance and external benchmarking efforts.

Methods: Data were derived from the National Trauma Data Bank (2007-8.

Disparity in management and long-term outcomes of pediatric splenic injury in California.

Objective: To determine the impact of evidence-based guidelines on the disparities in management of pediatric splenic injuries (PSI).

Summary Of Background Data: Several studies have highlighted a disparity in the utilization of nonoperative management (NOM) for PSI based on hospital and surgeon characteristics. Whether evidence-based guidelines had an impact on mitigating this disparity is uncertain.

Acute secondary adrenal insufficiency after traumatic brain injury: a prospective study.

Objective: To determine the prevalence, time course, clinical characteristics, and effect of adrenal insufficiency (AI) after traumatic brain injury (TBI).

Design: Prospective intensive care unit-based cohort study.

Setting: Three level 1 trauma centers.