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Journal ArticleDOI

Outcome of Hospitalized Injured Patients After Institution of a Trauma System in an Urban Area

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TLDR
Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.
Abstract
Objective. —To determine if risk of death for hospitalized injured patients changes when an urban trauma system is implemented. Design. —An analysis of the risk of death in hospitalized injured patients in 1984 and 1985 (pretrauma system), 1986 and 1987 (early trauma system), and 1990 and 1991 (established trauma system) using hospital discharge abstract data. Setting. —A total of 18 acute care hospitals in the four-county area encompassing Portland, Ore. Patients. —A cohort of 70 350 hospitalized patients with at least one discharge diagnosis indicating injury. Main Outcome Measure. —Death during hospitalization. Results. —After the trauma system was established, 77% of patients in the region with an Injury Severity Score (ISS) of 16 or greater were admitted to level I trauma centers. More than 72% of patients with an ISS less than 16 were hospitalized in nontrauma centers. Risk of death for injured patients hospitalized at level I trauma centers declined after the trauma system was established (odds ratio, 0.65; 95% confidence interval, 0.51 to 0.81). Patients who died in trauma centers after institution of the trauma system were younger and had more severe injuries, and the majority died within 1 day of admission, whereas patients who died in nontrauma centers died a median of 5 days after admission. Conclusion. —Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate. ( JAMA . 1994;271:1919-1924)

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European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.

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European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care.

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References
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Book

Applied Logistic Regression

TL;DR: Hosmer and Lemeshow as discussed by the authors provide an accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets.
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Modeling and variable selection in epidemiologic analysis.

TL;DR: An overview of problems in multivariate modeling of epidemiologic data is provided, and some proposed solutions are examined, including model and variable forms should be selected based on regression diagnostic procedures, in addition to goodness-of-fit tests.
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A revision of the Trauma Score.

TL;DR: T-RTS, the sum of coded values of GCS, SBP, and RR, demonstrated increased sensitivity and some loss in specificity when compared with a triage criterion based on TS and GCS values, and RTS demonstrated substantially improved reliability in outcome predictions compared to the TS.
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Investigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State Hospitals

TL;DR: An improved measure of physician volume is used to test the combined relationship of hospital and physician volume with in-hospital mortality rates and to explore the existence of threshold volumes that optimally discriminate high- and low-volume providers.
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