Archive for September, 2014

One Third of all U.S. Trauma Patients and More than Half of the Elderly are Undertriaged

Wednesday, September 24th, 2014

A study conducted by the¬†Center for Pediatric Trauma Research and the Center for Injury Research and Policy at Nationwide Children’s Hospital found that 34% of major trauma patients in the U.S. are undertriaged. That means that patients are being served by level III trauma centers or non-trauma centers, rather than level I or level II facilities as recommended by the American College of Surgeons Committee on Trauma.

The study, published in the September 2014 issue of the American Journal of Emergency Medicine, used 2010 data on trauma patients whose level of care was known. Seriously injured patients above the age of 74 were the most likely to be undertriaged. Knowing that patients treated at level I trauma centers have a 25% lower risk of death than those treated at non-trauma centers, the undertriage problem is troubling.

Explanations for the high numbers of undertriaged patients include the scarcity of appropriate centers: nearly 43 million Americans live more than an hour’s drive from a level I or level II trauma center. Other factors could be weather conditions, end-of-life directives, inadequate training, lack of familiarity with triage protocols, and age bias.

Read more.

Too Many U.S. Troops Lost Lives When Survival Was Possible

Tuesday, September 23rd, 2014

A Sept. 19 Wall Street Journal article illuminates a study published last year in which military trauma researchers found that 24% of the American servicemen and women killed in action over the past 10 years died from potentially survivable wounds–nearly 1,000 troops.

The study, conducted by the U.S. Army Institute of Surgical Research, found that battlefield aid techniques used by some elite units had not found their way into common usage across the rest of the military–techniques such as the use of tanexamic acid as an anti-bleeding agent, junctional tourniquets to stem hemorrhage that occurs close to the trunk, and ketamine as an alternative pain killer that does not depress blood pressure.

While best practices have made it to the battlefield in some cases, the latest gear, drugs and techniques are still inconsistently utilized. Military trauma surgeons interviewed for the story, including Brian Eastridge, an Army Colonel and member of the National Trauma Institute’s Board of Directors, say that bureaucratic issues, the lack of trauma specialists in the field, and a lack of focus on pre-hospital care have all contributed to the problem.

With the return of American forces to the Mideast, some fear that frontline care will be even less adequate, as the expected scattered conflicts will involve smaller units without the extensive evacuation and hospital networks that were in place in Iraq and Afghanistan.

Read the full story:  WSJ 140919 Preventable Deaths.

NTI-Funded Study Finds that Clinical Practice Compliance Saves Lives

Tuesday, September 2nd, 2014

Trauma Center compliance with recommended clinical practices is not uniform, and increased adherence leads to improved patient outcomes, finds recently published research conducted by Shahid Shafi, MD, MPH, FACS, and colleagues.

Shafi’s study, funded with a grant from the National Trauma Institute, sought to determine whether variations in specific clinical practices affect patient outcomes. The authors focused on a set of 22 measurable clinical practices related to traumatic brain injury, hemorrhagic shock, pelvic fractures and long-bone external fractures.

The retrospective observational study conducted with data from five Level 1 Trauma Centers indicated that 100% compliance with the 22 commonly recommended practices was associated with a 58% reduction in mortality.

Read more in the Journal of the American College of Surgeons 2014;219:189-198.