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Statewide Analysis Shows Collaborative Regional Trauma Network Reduces Regional Mortality.

Abstract A Regional Trauma Network (RTN), composed of one level I and several lower-level trauma centers (TCs) across multiple hospital systems, was established in 2010. This collaborative network used a unified triage protocol and a single transfer center. The impact of this RTN was assessed by evaluating regional mortality changes before and after RTN establishment. Patients in the state trauma registry aged 15 and older from 2006 to 2012 were analyzed; 2006 to 2009 and 2010 to 2012 were designated as pre-RTN and RTN periods, respectively. The region was defined as a county containing L1TC and its adjacent counties. Any counties bordering multiple L1TC-containing counties were excluded from analysis. Mortality was compared for all regions before and after RTN implementation. The following subgroups were also included a priori for the comparison: Injury Severity Score ≥15, age ≥65, and trauma mechanisms. 121,448 patients were analyzed; 66,977 and 54,471 patients were in the pre-RTN and RTN groups, respectively. Mean age was 58; 90 per cent had blunt injuries. The overall mortality was 4.9 per cent. Mortality comparisons over time for all regions are presented. The RTN region was the only region in the state that had mortality reduction in all patient subgroups. After adjusting for age, Injury Severity Score, level of TC that performed treatment, and trauma mechanism, RTN implementation was an independent predictor of survival (odds ratio: 0.876; 95% CI: 0.771-0.995, P = 0.04, c-statistic: 0.84). These findings suggest that regional collaboration and network-wide, uniform triage practices should be key components in the development of regionalized trauma networks.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 29580364
OWN - NLM
STAT- MEDLINE
DCOM- 20180404
LR  - 20180404
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 84
IP  - 2
DP  - 2018 Feb 1
TI  - Statewide Analysis Shows Collaborative Regional Trauma Network Reduces Regional
      Mortality.
PG  - 309-317
AB  - A Regional Trauma Network (RTN), composed of one level I and several lower-level 
      trauma centers (TCs) across multiple hospital systems, was established in 2010.
      This collaborative network used a unified triage protocol and a single transfer
      center. The impact of this RTN was assessed by evaluating regional mortality
      changes before and after RTN establishment. Patients in the state trauma registry
      aged 15 and older from 2006 to 2012 were analyzed; 2006 to 2009 and 2010 to 2012 
      were designated as pre-RTN and RTN periods, respectively. The region was defined 
      as a county containing L1TC and its adjacent counties. Any counties bordering
      multiple L1TC-containing counties were excluded from analysis. Mortality was
      compared for all regions before and after RTN implementation. The following
      subgroups were also included a priori for the comparison: Injury Severity Score
      >/=15, age >/=65, and trauma mechanisms. 121,448 patients were analyzed; 66,977
      and 54,471 patients were in the pre-RTN and RTN groups, respectively. Mean age
      was 58; 90 per cent had blunt injuries. The overall mortality was 4.9 per cent.
      Mortality comparisons over time for all regions are presented. The RTN region was
      the only region in the state that had mortality reduction in all patient
      subgroups. After adjusting for age, Injury Severity Score, level of TC that
      performed treatment, and trauma mechanism, RTN implementation was an independent 
      predictor of survival (odds ratio: 0.876; 95% CI: 0.771-0.995, P = 0.04,
      c-statistic: 0.84). These findings suggest that regional collaboration and
      network-wide, uniform triage practices should be key components in the
      development of regionalized trauma networks.
FAU - Sajankila, Nitin
AU  - Sajankila N
FAU - He, Jack C
AU  - He JC
FAU - Zosa, Brenda M
AU  - Zosa BM
FAU - Allen, Debra L
AU  - Allen DL
FAU - Claridge, Jeffrey A
AU  - Claridge JA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Clinical Protocols
MH  - Community Networks/*organization & administration
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ohio/epidemiology
MH  - Patient Transfer
MH  - Registries
MH  - Retrospective Studies
MH  - Trauma Centers/*organization & administration
MH  - Triage
MH  - Wounds and Injuries/diagnosis/*mortality/*therapy
MH  - Young Adult
EDAT- 2018/03/28 06:00
MHDA- 2018/04/05 06:00
CRDT- 2018/03/28 06:00
PHST- 2018/03/28 06:00 [entrez]
PHST- 2018/03/28 06:00 [pubmed]
PHST- 2018/04/05 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2018 Feb 1;84(2):309-317.