The effect of preexisting conditions on mortality in trauma patients

Article Abstract:

One group of factors important in determining the response to trauma are so-called 'host factors', such as age, sex, and pre-existing disease of the patient. Since the relationship between pre-existing disease and mortality after trauma has not been determined, these factors were investigated for 3,074 people who died following trauma in California in 1983. Computerized hospital discharge records were analyzed, which contained demographic information as well as information about the hospitalization, diagnoses, and procedures. Two computed scores were used for each patient to express the severity of trauma. Each trauma victim (a case) was statistically matched with, at most, four survivors of similar episodes who had been discharged from the same hospital and were of similar age (controls; 9,869 were studied). Cases and controls were then compared to determine the incidence of preexisting conditions (PECs). Eleven of these, including hypertension (high blood pressure), diabetes, chronic liver disease, obesity, and others, were singled out for analysis. Results showed that 59 percent of the deaths occurred among patients 55 years old or older, and that nearly three fourths of the deaths were due to trauma of relatively minor severity, most involving hip fractures. Patients with one or more of the 11 PECs were 30 percent more likely to die than those without PECs; with two or more PECs, they were 60 percent more likely. The PECs that had the most effect on risk of dying after trauma were cirrhosis of the liver (a chronic condition) and congenital coagulation defects (disorders of blood clotting present from birth), but chronic obstructive pulmonary disease (a lung disorder), ischemic heart disease (inadequate blood supply to the heart), and diabetic patients, still had an increased risk. It was interesting that trauma victims with hypertension or psychoses were less likely to die than patients without. PEC prevalence for California hospital admissions is provided. The effect of PECs on mortality was greatest among patients with mild or moderate injury; for the rest, it varied with age of the patient, being least for the oldest patients (due to the method of analysis: these patients already had a high risk of dying). The findings suggest that PECs contribute to increased risk for all patients suffering moderate trauma, and that the adult aged 45 to 54 is at increased risk after injury of any severity. They suggest further that the PECs found important here should be taken into account in triage (classification and decision about treatment) of trauma patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hospitals, Hospital emergency services

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Progress in the development of trauma systems in the United States: results of a national survey

Article Abstract:

Very few comprehensive trauma systems appear to exist in the United States. Trauma systems are programs designed to coordinate and facilitate care of critically injured patients. Trauma systems typically include designated trauma centers, protocols for assessing patient injuries before admission, and ongoing evaluation of trauma centers. Thirty-seven trauma system directors or administrators completed questionnaires about their trauma systems. Administering organizations have legal authority to designate trauma centers in Washington, DC, and 20 states. Seventeen of the respondents from state and regional authorities indicated that the number of trauma centers is limited based on community need. Evaluation of the transfer arrangements between hospitals indicated that four of five Florida regional authorities, and nine of 12 California regional authorities had written transfer policies. Regional authorities were responsible for interhospital transfers in Massachusetts. In order to function more efficiently trauma systems should limit the number of trauma centers based on community need, implement clear policies for interhospital transfers and develop centralized trauma-patient registries.

Medical policy, Health policy

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National inventory of hospital trauma centers

Article Abstract:

There were 1,154 hospital trauma centers in the US in 2002, compared to 471 in 1991. However, the per capita number of trauma centers ranges from 0.19 per million people in Arizona to 42 per million people in North Dakota. Many states have no level III, IV, and V trauma centers to treat more advanced injuries.

United States, Labor Distribution by Employer, Statistics, Demographic aspects

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