A survey of the National Trauma Databank from 2002 to 2008 showed that up to 22 percent of gunshot-wound patients and 34 percent of stab-wound patients were not treated with immediate surgery. Nonsurgical treatment results in shorter hospital stays and fewer complications, and is desirable, provided the treatment facility has emergency surgeons to jump in if a patient’s condition deteriorates.

Read more about this John Hopkins University study by Drs. Adil Haider and Amy Rushing, as reported on NPR.

Reporting in the Archives of Surgery, Dr. Laurent Glance of the U of Rochester Medical Center, and colleagues noted that while some trauma care quality indicators are associated with how well trauma patients do, others are not. There are 16 quality indicators, issued by the American College of Surgeons Committee on Trauma, that include everything from interventions such as CT scans for patients with Glascow Coma scores less than 13, to completing proper documentation.

In a critique of the report, Dr. Charles Mabry of the University of Arkansas for Medical Sciences, said that the COT’s process measures are useful to determine why some hospitals do better in their treatment of trauma patients, but that they do not measure outcomes very well.

Some of Glance’s findings related to data on 210,942 trauma patients in Pennsylvania trauma centers include:
•8% of patients admitted with a gunshot wound to the abdomen were managed nonoperatively and had nearly a five-fold increase in the risk of death.
•20% of those with an admission coma score of less than 13 did not get a head CT scan, an omission that was associated with an adjusted odds ratio (AOR) for death of 4.39.
•19% of patients needed a laparotomy but did not have it within two hours. The delay was associated with a lower mortality risk.
•Measures of incomplete or incorrect documentation were not associated with increased risks.

Click here for a more detailed discussion of the report.

A study that mined data from the National Pediatric Data Registry found that children with head injuries treated at a standard trauma center were three times more likely to die than those taken directly to a Level 1 pediatric children’s hospital.

The specialists at pediatric trauma centers have received training in residencies and fellowships specific to children. “Through a better understanding of the differences between a child and adult, in addition to improved survival, pediatric specialists will manage your child with fewer X-rays, transfusions and earlier return to function,” observes nurse Diana Krauss and Dr. Martin Keller of St. Louis Children’s Hospital, in an article posted at STL Health and Fitness.

The age-appropriate treatment that children receive in pediatric trauma centers can also mean the difference between a quick recovery and months of rehabilitation.