Journal ArticleDOI
A National Evaluation of the Effect of Trauma-Center Care on Mortality
Ellen J. MacKenzie,Frederick P. Rivara,Gregory J. Jurkovich,Avery B. Nathens,Katherine Frey,Brian L. Egleston,David S. Salkever,Daniel O. Scharfstein +7 more
TLDR
It is shown that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.Abstract:
BACKGROUND Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers). METHODS Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers. RESULTS After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries. CONCLUSIONS Our findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.read more
Citations
More filters
Journal ArticleDOI
Multiple Imputation for Nonresponse in Surveys
TL;DR: It is concluded that multiple Imputation for Nonresponse in Surveys should be considered as a legitimate method for answering the question of why people do not respond to survey questions.
Journal ArticleDOI
European Resuscitation Council Guidelines for Resuscitation 2010 Section 4 Adult advanced life support
Charles D. Deakin,Jerry P. Nolan,Jasmeet Soar,Kjetil Sunde,Rudolph W. Koster,Gary B. Smith,Gavin D. Perkins +6 more
TL;DR: Cardiothoracic anesthetic, Southampton General Hospital, Southampton, UK Anesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK Anaesthesia and intensive care medicine, Southmead Hospital, Bristol, UK Surgical ICU, Oslo University Hospital Ulleval, Oslo, Norway Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Critical Care and Resuscitation, University of Warwick, Warwick Medical School, Warwick, UK
Journal ArticleDOI
Moderate and severe traumatic brain injury in adults.
TL;DR: New developments and current knowledge and controversies, focusing on moderate and severe TBI in adults, are summarised, with an emphasis on epidemiological monitoring, trauma organisation, and approaches to management.
Journal ArticleDOI
The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition
Rolf Rossaint,Bertil Bouillon,Vladimir Cerny,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Daniela Filipescu,Beverley J. Hunt,Radko Komadina,Giuseppe Nardi,Edmund Neugebauer,Yves Ozier,Louis Riddez,Arthur Schultz,Jean Louis Vincent,Donat R. Spahn +15 more
TL;DR: The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation, and may also serve as a basis for local implementation.
Journal ArticleDOI
European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary.
Jerry P. Nolan,Jasmeet Soar,David Zideman,Dominique Biarent,Leo Bossaert,Charles D. Deakin,Rudolph W. Koster,Jonathan Wyllie,Bernd W. Böttiger +8 more
TL;DR: This book discusses Anaesthesia and Intensive Care Medicine, neonatology and Paediatrics, and any Anasthesiologie und Operative Intensivmedizin, which may apply to these fields.
References
More filters
Journal ArticleDOI
A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation☆
TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
Book
Multiple imputation for nonresponse in surveys
TL;DR: In this article, a survey of drinking behavior among men of retirement age was conducted and the results showed that the majority of the participants reported that they did not receive any benefits from the Social Security Administration.
Journal ArticleDOI
The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care
TL;DR: Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.
Journal ArticleDOI
Marginal Structural Models and Causal Inference in Epidemiology
TL;DR: In this paper, the authors introduce marginal structural models, a new class of causal models that allow for improved adjustment of confounding in observational studies with exposures or treatments that vary over time, when there exist time-dependent confounders that are also affected by previous treatment.
Journal ArticleDOI
Multiple Imputation for Nonresponse in Surveys
TL;DR: It is concluded that multiple Imputation for Nonresponse in Surveys should be considered as a legitimate method for answering the question of why people do not respond to survey questions.