Trauma Centers Save More Lives

The findings could help save facilities threatened with closure, experts say

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By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Jan. 25, 2006 (HealthDay News) -- New findings could boost the survival of regional trauma centers across the United States, which are increasingly threatened with closure by rising costs.

A study in the Jan. 26 issue of the New England Journal of Medicine finds that patients treated at trauma centers are much more likely to survive than patients treated at non-trauma centers.

"Our biggest hope is that by providing, for the first time, some pretty solid evidence that trauma centers make a difference in terms of risk, that hospitals and states can use that to argue for keeping trauma centers open," said study author Ellen J. MacKenzie, chairwoman of the department of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore.

Trauma centers provide the resources necessary to take care of severely injured patients. However, a combination of fiscal pressures and lack of evidence on their effectiveness has cast a shadow on their future.

"Areas around the country and hospitals are struggling, in part, because of the pressures on the health-care system overall," MacKenzie said. "But I think trauma centers are particularly vulnerable because they treat a disproportionate share of uninsured and underinsured people, and they have high standby costs."

Standby costs come largely from the fact that trauma centers have to be available 24/7, even though they may not treat patients 24/7.

"It's very much a team approach, and the team involves specially trained doctors and nurses and a range of other specialists including neurosurgeons, anesthesiologists and orthopedic surgeons," MacKenzie explained. "Typically, all of those specialists will have to be in the hospital or within 10 or 15 minutes from the hospital, and they have to be available around the clock."

The big question, however, has been just how lifesaving this type of system is.

The current study was designed to address that question by comparing treatment at hospitals with a level 1 trauma center (the most specialized type) to that of hospitals without a trauma center, referred to as non-trauma centers.

The authors looked at death rates among patients treated in 18 hospitals with a level 1 trauma center and 51 non-trauma centers across 14 states. To be eligible, patients had to be 18 to 84 years old with a moderate-to-severe injury. In all, the researchers obtained complete data for 1,104 patients who died in one of the hospitals and 4,087 patients who were discharged alive.

The result: The in-hospital mortality rate was 7.6 percent at trauma centers and 9.5 percent at non-trauma centers, a 25 percent relative difference.

The one-year mortality rate was 10.4 percent for patients who had been treated at a trauma center vs. 13.8 percent for patients treated elsewhere.

"This confirms what those of us who do this every day already know, that these dedicated resources do change outcomes," said Dr. Maurizio Miglietta, chief of trauma and critical care at New York University School of Medicine/Bellevue Hospital in New York City.

The study also pointed up differences in risk according to the severity of the injury, with the impact greatest among those with the most severe injuries.

That was not surprising. More surprising was the fact that the impact was greater among younger vs. older patients. It's not clear why this might be so, but it may be due to the fact that older people have more medical conditions to begin with.

The authors are now planning to take a more in-depth look at trauma centers, turning their attention to whether they make a difference in patient's quality of life and functional outcomes.

"Most people in the trauma business agree that we need political and public support for trauma centers to stay viable," MacKenzie said. "We're very hopeful that this information can bolster that argument."

"It really points out to government and hospital administrators that it's not all about financing," Miglietta added. "It's about people's lives, and it's the right thing to do."

More information

For more on preventing injuries, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Ellen J. MacKenzie, Ph.D., professor and chairwoman, department of health policy and management, Johns Hopkins Bloomberg School of Public Health, Baltimore; Maurizio Miglietta, D.O., chief, trauma and critical care, New York University School of Medicine/Bellevue Hospital, New York City; Jan. 26, 2006, New England Journal of Medicine

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