Lower death rates seen when severely injured patients are sent directly to trauma centers

The findings of a retrospective cohort-designed study show that transporting severely injured patients directly to trauma centers rather than closer hospitals without trauma centers resulted in a nearly 25% lower death rate.

“Trauma centers save lives,” Avery B. Nathens, MD, PhD, FACS, trauma director at Toronto’s St. Michael’s Hospital and an investigator for the study, stated in a hospital press release.

The research appeared online in the Journal of the American College of Surgeons.

Up to 85% of North Americans live within a 1-hour flight or drive of a trauma center, yet 30% to 60% of severely injured patients are taken to the nearest hospital, according to the release.

Patient deaths

Nathens and his colleagues studied 11,398 severely injured patients who were treated in Ontario between 2002 and 2007. The investigators found that 66% were transported directly to one of nine Ontario adult trauma centers, while 30% were initially assessed at the closest hospital and then transferred to trauma centers.

Overall, 18% of patients (2,065 people) died; 4% died before they could be transferred to a trauma center. This accounted for 22% of all the deaths.

Previous studies examining this topic excluded severely injured patients, and that may have led physicians to assume that patients taken directly to trauma centers had the same death rates as those who were not initially treated at such centers.

Need for innovation

By looking at the outcomes of all these patients, Nathens and his colleagues found that the risk of dying was 24% greater when patients first stopped at non-trauma facilities.

“We acknowledge that access to these trauma centers can be a challenge, given Ontario’s geography,” Nathens stated in the release. “So we have to find innovative ways to make sure that hospitals and providers who received these patients are equipped with the highest level of skills and resources to provide optimal care and means to transfer them ASAP.”

In 2006, a trauma expert panel appointed by the Ontario Ministry of Health and Long-Term Care recommended the provincial government develop five classes of trauma services and required that each hospital be able to perform its level of care. It also recommended developing target times and criteria on which trauma patients’ transfers to trauma centers should be based, according to the release.

Reference:
Haas B, Gomez D, Zagorski B, et al. Survival of the fittest: The hidden cost of undertriage of major trauma. Journal of the American College of Surgeons. DOI: 10.1016/j.jamcollsurg.2010.08.014.

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