Trauma Center Patients Research Articles

Suicides, Homicides, and Unintentional Injury Deaths After Trauma Center Discharge: Cocaine Use as a Risk Factor

: To study whether trauma center patients with positive toxicology findings for cocaine-positive (COC+) are at a higher risk for suicide, homicide, and unintentional injury death after discharge than cocaine-negative (COC+) trauma patients. : Patients admitted between July 1983 and June 1995 and discharged alive from a level I trauma center were prospectively followed up for 1.5 years to 14.5 years. The occurrence of suicide, homicide, and unintentional injury death was explored in relation to COC+ status at admission using Cox proportional hazards methodology. Models included possible confounders. Interactions with each of the main effects were explored. : Of the 27,399 admissions, 21,500 had urine COC toxicology testing performed and were included in the study. COC was positive in 11.4% of the studied population. COC+ patients were significantly younger, with 72% of COC+ versus 43% of COC- in the 25 to 44 years age group. COC+ patients were more likely to be men, positive for alcohol, and intentional injury victims. COC+ status was not associated with subsequent suicide. Furthermore, the COC+ status association with subsequent homicide became nonsignificant after adjusting for confounders. Unadjusted COC+ status was associated with unintentional injury death (odds ratio = 1.65 [1.14-2.40]). Interactions were found in the association with unintentional injury death such that COC+ status tripled the odds of injury death (odds ratio = 2.75 [1.58-4.78]) among the alcohol-negative patients within the 25 to 45 years age group. : COC+ trauma patients are at an increased risk of subsequent unintentional injury death after discharge from a trauma center. Suicide and homicide occurrence seems to be unaffected.

Creating a Nationally Representative Sample of Patients From Trauma Centers

The National Trauma Data Bank (NTDB) was developed as a convenience sample of registry data from contributing trauma centers (TCs), thus, inferences about trauma patients may not be valid at the national level. The NTDB National Sample was created to obtain nationally representative estimates of trauma patients treated in the US level I and II TCs. Level I and II TCs in the Trauma Information Exchange Program were identified and a random stratified sample of 100 TCs was selected. The probability-proportional-to-size method was used to select TCs and sample weights were calculated. National Sample Program estimates from 2003 to 2006 were compared with raw NTDB data, and to a subset of TCs in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a population-based dataset drawn from community hospitals. Weighted estimates from the NTDB National Sample range from 484,000 (2004) to 608,000 (2006) trauma incidents. Crude NTDB data over-represented the proportion of younger patients (0 years-14 years) compared with the NTDB National Sample, which does not include children's hospitals. Few TCs in Trauma Information Exchange Program are included in Healthcare Cost and Utilization Project Nationwide Inpatient Sample, but estimates based on this subset indicate a higher percentage of older patients (age 65 year or older, 23.98% versus 17.85%), lower percentage male patients, and a lower percentage of motor vehicle accidents compared with NTDB National Sample. Although nationally representative data regarding trauma patients are available in other population-based samples, they do not represent TCs patients and lack the specificity of National Sample Program data, which contains detailed information on injury mechanisms, diagnoses, and hospital treatment.

Level I Versus Level II Trauma Centers: An Outcomes-Based Assessment

Trauma centers improve outcomes compared with nontrauma centers, although the relative benefit of different levels of major trauma centers (Level I vs. Level II hospitals) remains unclear. We sought to determine whether there was a difference in the patient outcome in trauma victims taken to Level I versus Level II trauma centers. A multicenter, retrospective cohort analysis of all patients with trauma (>15 years), meeting State of Ohio trauma criteria, transported directly from the scene to a Level I or a Level II hospital (27 centers) between January 2003 and December 2006. Propensity score adjustment was used to adjust for nonrandom selection of hospital destination (I vs. II) and included age, emergency medical services (EMS) Glasgow Coma Score, comorbidities, EMS systolic blood pressure, injury type, injury severity, EMS procedures, emergency department procedures, gender, insurance status, and race. A propensity-adjusted multivariable logistic regression model was used to test the association between trauma center level and patient outcomes. Outcomes included in-hospital mortality and discharge destination (skilled nursing facility, rehabilitation center, home). A total of 18,103 patients were included in the analysis; 10,070 (56%) were transported to a Level I center. Patients taken to Level I centers had more severe injuries, more penetrating injuries, more complications, yet similar unadjusted mortality compared with Level II centers. In adjusted analyses, patients taken to Level I hospitals had improved survival compared with Level II centers (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.56-0.98). Similar results were seen when restricting the analyses to patients with serious injuries (Injury Severity Score > 15; EMS Glasgow Coma Score < 9). Patients treated at Level I hospitals were more likely to be discharged home (OR 1.14, 95% CI 1.05-1.25), or a rehabilitation center or skilled nursing facility (OR 1.39, 95% CI 1.27-1.52). Patients taken to Level I centers had improved survival and better functional outcomes compared with injured persons taken to Level II hospitals.

Predictors of Posttraumatic Deep Vein Thrombosis (DVT): Hospital Practice Versus Patient Factors—An Analysis of the National Trauma Data Bank (NTDB)

Trauma centers that perform more duplex ultrasounds report more deep vein thromboses (DVT). However, it is uncertain if this is due to variations in hospital practices or patient characteristics and case mix. We hypothesize that admission to trauma centers that use duplex ultrasound more frequently, independently predicts DVT reporting for individual patients, controlling for patient-level risk factors. We analyzed patients from trauma centers reporting at least one vascular ultrasound and one DVT to the National Trauma Data Bank (v6.2). Because National Trauma Data Bank contains no data on hospital duplex surveillance practice, we defined "screening" trauma centers as those performing ultrasound on more than 2% of patients. The primary outcome measure was DVT diagnosis. Multiple logistic regression was performed, using patient-level risk factor covariates as well as hospital duplex rate to compare patients at "screening" versus "non-screening" trauma centers. Sensitivity analysis was performed by varying duplex rate cutoff, outcome measure, and patient population. Approximately half of 492,496 patients were admitted to "screening" trauma centers. Unadjusted DVT rate was threefold higher in "screening" trauma center patients (1.18% vs. 0.35%, p < 0.001). Age > or = 40 years, extremity injury, head injury, ventilator days > or = 3, venous injury and major surgery were independently associated with DVT diagnosis. "Screening" trauma center admission was independently associated with a higher likelihood of DVT reporting (odds ratio, 2.16; 95% confidence interval, 1.07-4.34). No qualitative differences were identified on sensitivity analyses. Trauma center ultrasound practice is an independent predictor of DVT diagnosis for individual patients, controlling for patient-level risk factors. Elevated DVT rates at these centers are due to surveillance bias. In the absence of standardized surveillance, hospital DVT rate is an inappropriate quality of care measure after trauma.

Alcohol Abuse and Illegal Drug Use Among Los Angeles County Trauma Patients: Prevalence and Evaluation of Single Item Screener

The misuse of alcohol and illicit drugs is implicated with injury and repeat injury. Admission to a trauma center provides an opportunity to identify patients with substance use problems and initiate intervention and prevention strategies. To facilitate the identification of trauma patients with substance use problems, we studied alcohol abuse and illegal substance use patterns in a large cohort of urban trauma patients, identified correlates of alcohol abuse, and assessed the utility of a single item binge-drinking screener for identifying patients with past 12-month substance use problems. Between February 2004 and August 2006, 677 patients from four large trauma centers in Los Angeles County were interviewed. The sample was broadly representative of the entire Los Angeles County trauma center patient population. Twenty-four percent of patients met criteria for alcohol abuse and 15% reported using an illegal drug other than marijuana in the past 12 months. Male gender, assaultive injury, peritrauma substance use, and history of binge drinking were prominent risk factors. A single item binge drinking screen correctly identified alcohol abuse status in 76% of all patients; the screen also performed moderately well in discriminating between those who had or had not used illegal drugs in the past 12 months, with sensitivity estimates reaching 0.79 and specificity estimates reaching 0.74. A large proportion of urban trauma patients abuse alcohol and use illegal drugs. Distinct sociodemographic and substance use history may indicate underlying risky behaviors. Interventions and injury prevention programs need to address these causal behaviors to reduce injury morbidity and recidivism. In the busy trauma care setting, a one-item screener could be helpful in identifying patients who would benefit from more thorough assessment and possible brief intervention.

Improved trauma patient outcomes after implementation of a dedicated trauma admitting service

Background Regionalised trauma systems have been shown to improve the outcome of seriously injured patients. However, it is not clear which components of these systems have the most impact on patient outcomes. The study evaluates the association between implementation of a single, dedicated trauma admitting service at an urban trauma centre and subsequent patient outcomes. Methods This was a retrospective review of prospectively collected trauma registry data at the St George Public Hospital, a level I urban trauma centre in Sydney, Australia. Two concurrent 18-month periods, before and after implementation of a full-time trauma service, were compared for differences in patient mortality, complication rates, and ED, ICU and hospital lengths of stay. Results There were 962 patients admitted to the hospital in the 18 months immediately preceding the implementation of the trauma service (the PRE group) and 990 patients in the subsequent 18 months (the POST group). There were no significant differences between groups with respect to patient demographics or mechanism of injury, although a higher proportion of patients in the POST group had injury severity scores (ISS) above 15 (30.6% versus 24.8%, p = 0.02). There was an 8% reduction in death rate among the most severely injured patients (ISS > 15), in the POST group as compared to the PRE group (12.2% and 20.2% respectively, p = 0.007). Conclusions The implementation of a full-time trauma service in this hospital was associated with a reduction in death rate among the most severely injured patients, and a decrease in LOS in patients with an ISS < 15.

Smoking Is a Marker of Risky Behaviors Independent of Substance Abuse in Injured Drivers

Objective. Smoking has been linked to disease and injury. The purpose of this study is to investigate the smoking habits of motor vehicular driver trauma center patients and their association with previous injury history and risky behaviors. Methods. The studied population included 323 motor vehicular driver injury patients (123 smokers and 200 non-smokers) interviewed as part of a larger study of psychoactive substance use disorders at an adult Level I trauma center. Patients with head injuries, hospital stays of less than two days, and diminished cognition were excluded. Interviews included demographics (age, gender, race, marital status), socioeconomic status (SES; income, education, employment), risky behaviors (seatbelt non-use, drinking and driving, riding with drunk driver, binge drinking), and trauma history information (vehicular, assault, and other injuries). Substance abuse (alcohol and drug dependence) was evaluated in depth using DSM III-R criteria. Smokers and non-smokers were compared in relation to control and dependent variables using student's t test and chi-square (α = 0.05). Outcome variables included previous trauma history and risky behaviors. Multiple logistic regression models using step-down selection methods (α = 0.05) were constructed with risky behaviors and trauma history as dependent variables including demographics, SES and substance as independent variables. Results. Smokers represented 38 percent of the 323 patients studied. Smokers (n = 123) were younger (34 vs. 43 years), more likely to be male (72 percent vs. 50 percent), not married (72 percent vs. 56 percent), and had higher rates of alcohol (29 percent vs. 9 percent) and drug dependence (14 percent vs. 3 percent) than non-smokers (n = 200). Educational achievement (20 percent vs. 15 percent less than high school) and income level (24 percent vs. 23 percent with less than $15,000 of yearly income) were not different between smokers and non-smokers. Smokers were more likely than non-smokers to have a history of prior vehicular trauma (48 percent vs. 26 percent), assault (25 percent vs. 9 percent), or other injury (50 percent vs 37 percent). The following injury-prone behaviors were also more common among the smokers than non-smokers: seatbelt non-use (49 percent vs. 29 percent), drinking and driving (38 percent vs. 15 percent), riding with drunk driver (38 percent vs. 13 percent), and binge drinking (68 percent vs. 26 percent). In multiple logistic regression models adjusting for demographics, SES, and substance abuse, smoking revealed significantly higher odds ratios (OR) for the following dependent variables: seatbelt non-use (OR = 2.9), riding with drunk driver (OR = 2.2), binge drinking (OR = 2.4), previous vehicular (OR = 2.0), and assault injuries (OR = 2.5). Smoking did not reach significance for drinking and driving and other (non-vehicular and non-assault) injury. Conclusion. Smoking is independently associated with risky behaviors and repeated history of vehicular or assault injury within the vehicular trauma population.

A Controlled Trial of Brief Intervention Versus Brief Advice for At-Risk Drinking Trauma Center Patients

Numerous reports document that preinjury alcohol use is associated with all modes of injury requiring treatment in a trauma center, with 25% to 50% or more of patients testing positive for alcohol at the time of admission. There is evidence that in trauma patients unaddressed alcohol use problems result in recurrent injury requiring readmission to a trauma center and/or death. A randomized clinical trial was conducted to assess the effectiveness of two types of brief interventions to reduce drinking and the consequences of drinking. Trauma patients defined as at-risk alcohol users (n=497) were randomized into two treatment options: a brief personalized motivational intervention (PMI), or brief information and advice (BIA). After a brief assessment, PMI subjects received a motivational session, feedback letter, and two postdischarge telephone contacts, whereas the BIA group received a brochure and one postdischarge telephone contact. Both groups were reassessed at 6 and 12 months postinjury. Both the PMI and BIA groups had statistically significant reductions in drinking, binge episodes, and consequences related to drinking that persisted from the 6- to the 12-month follow-up. However, although not statistically significant, for those classified as lower-level drinkers (<or=1 drink per day), there was a consistent pattern of maintaining reductions for the PMI group at 12 months compared with the BIA group. Our results suggest that brief interventions (PMI and BIA) that link alcohol consumption with trauma injury and consequences of drinking can be effective in reducing drinking and consequences related to drinking in a significant portion of at-risk nondependent drinkers.

A Pilot Study of Bibliotherapy to Reduce Alcohol Problems among Patients in a Hospital Trauma Center

Because alcohol use plays a major role in many injuries that require hospital care, there is increasing interest in developing interventions to address alcohol problems among emergency department and trauma center patients. The aim of the current study was to extend past research on brief interventions by investigating the use of a self-help manual to treat problem drinkers in a hospital trauma center. Forty injured patients who were either intoxicated at the time of injury or screened positive for harmful drinking were randomly assigned to receive either a brief assessment and a self-help booklet with no more than 5 minutes clinician contact (bibliotherapy) or brief assessment only. Follow-up data obtained five months after hospital discharge indicated that patients in both conditions made significant reductions in drinking and associated negative consequences. There was a trend toward further treatment-seeking among those in the bibliotherapy condition (40% versus 13%). Results suggest that the provisio...

Trauma Center Resource Consumption and Mortality

Studies suggesting that increased trauma center (TC) patient volume leads to improved patient outcomes have produced inconsistent results. It is possible that the combination of TC patient volume and TC resources has a greater influence over outcomes than TC volume alone. Patients admitted to 131 TCs from 1994 to 2002 were included. TC density was calculated as the ratio of TC adult beds to patient volume and categorized into quartiles. Adjusted risk ratios (RRs) and 95 per cent confidence intervals (CIs) compared mortality of groups (Q1 [low density]-Q4 [high density]). Relative to Q4 TCs, for penetrating injuries with ISS < 15, elevated mortality was seen for Q2 (low-moderate density) TCs (RR 1.47, CI 1.09-1.99) and Q3 (high-moderate density) TCs (RR 1.81, CI 1.36-2.41); but for ISS > or = 15, mortality was lowest for Q1 (RR 0.78, CI 0.68-0.89). For blunt injury, mortality was similar for low- and high-density TCs but elevated for low-moderate- and high-moderate-density TCs. Mortality at low-density TCs was decreased overall and for penetrating injuries specifically but similar for blunt injuries when compared with high-density TCs. Enhanced resources measurements will clarify the relationship between patient volume, resources, and mortality.

Is Outcome after Blunt Splenic Injury in Adults Better in High-Volume Trauma Centers?

An association between outcome and case volume has been demonstrated for selected complex operations. The relationship between trauma center volume and patient outcome has also been examined, but no clear consensus has been established. The American College of Surgeons (ACS) has published recommendations on optimal trauma center volume for level 1 designation. We examined whether this volume criteria was associated with outcome differences for the treatment of adult blunt splenic injuries. Using a state trauma database, ACS criteria were used to stratify trauma centers into high-volume centers (>240 patients with Injury Severity Score >15 per year) or low-volume centers, and outcome was evaluated. There were 1,829 patients treated at high-volume centers and 1,040 patients treated at low-volume centers. There was no difference in age, gender, emergency department pulse, emergency department systolic blood pressure, or overall mortality between high- and low-volume centers. Patients at low-volume centers were more likely to be treated operatively, but the overall success rate of nonoperative management between high- and low-volume centers was similar. These data suggest that ACS criteria for trauma centers level designation are not associated with differences in outcome in the treatment of adult blunt splenic injuries in this regional trauma system.

The Stages of Change: When are Trauma Patients Truly Ready to Change?

This article summarizes the Stages of Change model, which identifies five stages that people experience as they gradually move away from engaging in harmful behaviors to sustaining healthy behaviors. Patients in different stages of change need different kinds of interventions. The Stages of Change model enhances brief counseling interventions for trauma patients with substance use problems because counselors can now accurately choose an appropriate intervention strategy. The authors present three case studies illustrating the three earliest stages of change most commonly encountered in trauma center patients.

Physiologic trauma triage criteria in adult trauma patients: Are they effective in saving lives by transporting patients to trauma centers?

Trauma triage criteria have been in place for many years and were updated in 1999 by the American College of Surgeons. We are unaware of any studies that have directly examined the ability of these criteria to reduce short-term mortality by transporting patients to trauma centers rather than to noncenters. Retrospective observational cohort study of adult patients meeting physiologic triage criteria who were transported to 9 regional (Level I) trauma centers, 21 area (Level II) trauma centers, and 119 noncenters in New York in 1996 to 1998. For each triage criterion and for one or more of the criteria, odds ratios and their confidence intervals for mortality in regional and area trauma centers versus noncenters and odds ratios and their confidence intervals for mortality in regional centers versus area centers and noncenters were used to measure performance. Patients in regional trauma centers had considerably lower mortality than patients in area trauma centers and noncenters for two individual triage criteria and for patients with one or more triage criteria (odds ratio, 0.75; 95% CI, 0.63-0.90 for one or more criteria). Also, patients with head injuries who were treated in regional centers had notably lower mortality than patients in other hospitals (odds ratio, 0.67; 95% CI, 0.53-0.85). In New York, regional trauma centers exhibit considerably lower mortality than area trauma centers or noncenters for adult patients meeting specific physiologic triage criteria. It is important that population-based trauma systems with data from centers and noncenters be developed for the purpose of evaluating and redesigning trauma systems.

Severe Intimate Partner Violence and Alcohol Use among Female Trauma Patients

The lifetime prevalence of intimate partner violence (IPV) among women in the United States is reported to be between 18 and 50%. One-third of female homicide victims are killed by an intimate partner and alcohol is often involved. Despite these figures, 77% of women have never been screened for IPV. Substance abuse in male partners is known to place women at risk. We examined the role of female alcohol use on rates of severe IPV. Our hypotheses were: (1) the prevalence of IPV among women seen in trauma centers is greater than that found in national surveys; (2) alcohol problems among abused women and their partners are greater than those among non-abused women; (3) females and their partners alcohol problems are each independently associated with IPV; and (4) female trauma center patients support domestic violence screening. An in-person survey was administered to 95 consecutive adult female trauma patients admitted to a Level I Trauma Center. The survey included questions about past-year and lifetime severe IPV, female and male partner alcohol use, and willingness to participate in IPV screening and referral. The multivariate associations of female and partner alcohol use with past-year severe IPV were assessed with logistic regression. Nearly one-half (46.3%) of women reported a lifetime history of severe IPV, with 26% experiencing severe IPV in the past year. Past-year IPV was identified in 59.1% of women screening positive for drinking problems, but in only 12.7% of those screening negative for drinking problems (p = 0.001). Similarly, past-year IPV prevalence was 55.2% when the partner was a problem drinker versus 8.3% when he was not (p = 0.001). Multivariate analysis showed that female problem drinking (odds ratio [OR] = 5.8) and partner problem drinking (OR=8.9) were independent predictors of past-year severe IPV. The majority of women (90.5%) felt that it was appropriate for health care professionals to screen for IPV; 90% of women with a history of IPV thought screening was important and 71% wished a previous healthcare provider had asked them about it. Female trauma patients demonstrate a higher prevalence of severe IPV than the general population. IPV rates appear to be related to both female and partner alcohol misuse. Female trauma patients endorsed IPV screening and thus should be screened for alcohol use and IPV in a way that minimizes future violence risk. Further research is needed to elucidate whether intervention for alcohol misuse has an impact on rates of IPV in this population.

Is it an accident? Recurrent traumatic life events in level I trauma center patients compared to the general population

The trauma history screen developed for the National Comorbidity Survey (NCS) was used to assess prior trauma in a representative sample of injured acute care inpatients (n = 251). Adjusted logistic regressions compared the trauma histories of intentionally (n = 66) and unintentionally (n = 185) injured patients with NCS participants (n = 5873). Whereas only 11% of NCS respondents reported 4 or more lifetime traumas, 61% of intentionally injured patients (Adjusted OR = 7.97, 95% CI = 4.33, 14.68) and 40% of unintentionally injured patients (Adjusted OR = 4.26, 95% CI = 2.94, 6.16) reported 4 or more lifetime traumas. In adjusted analyses, inpatients were at increased risk for reporting all types of trauma except combat. Screening and intervention procedures that address the unique characteristics of this high-risk patient population are needed in the acute care setting.

Comparison of trauma center patient self-reports and proxy reports on the Alcohol Use Identification Test (AUDIT).

There has been increased attention on identifying alcohol problems among individuals admitted to trauma centers. Reports about patients' drinking made by significant others represent one potential method to address both concerns about the validity of patients' self-reports and the need to have a proxy measure for trauma patients who are unable to provide information about their drinking behavior. The present study evaluated the level of agreement between trauma patients' self-report and proxy report on the Alcohol Use Disorders Identification Test (AUDIT). The study consisted of patients admitted to a Level I trauma center who screened positive for potential alcohol problems, who completed the AUDIT and National Institute of Mental Health Diagnostic Interview Schedule (Form III-R), and who had a collateral who provided proxy information about the patient. Proxy informants completed the AUDIT on the basis of their knowledge and perception of patients' drinking behavior, as well as a checklist of alcohol-related problems experienced by the patients in the 30 days before admission. Patient- and proxy-completed AUDIT total and subscale scores were highly correlated and did not differ from one another except for the dependence subscale, with proxies indicating a higher number of symptoms than did patients. A relatively high percentage of agreement (77.5%) was found overall in the classification of patients as having or not having problem drinking on the basis of self-report and proxy AUDITs; 56.4% of both sources indicated a drinking problem and 21.1% of both agreed that there was not a problem. Patients classified as having problem drinking on self-report AUDITs were rated by proxies as having significantly higher levels of hazardous drinking, alcohol-related problems, and dependence symptoms than patients whose AUDIT classified their drinking as nonproblematic. The relative comparability of proxy- and patient-completed AUDIT scores and classifications suggests that patient and proxy reports corroborate and, in cases of trauma patients' inability to provide self-reports, may serve as proxies for patients' reports of drinking.

Organized trauma care: does volume matter and do trauma centers save lives?

Trauma is the leading cause of death during the first four decades of life. Since the 1970s, organized systems for trauma care, including a prehospital emergency medical system and a network of hospitals designated as trauma centers, have been developed. The model of the trauma system and its efficacy have been reviewed. Fundamental to the trauma system is its recognition in the field and the transportation to a trauma center of patients with more serious injuries. Each trauma center has to treat at least 240 severe trauma patients per year to increase experience. It is cost-effective that less severely injured patients be treated in nontrauma center's acute care facilities, according to the inclusive system model. The effectiveness of trauma systems has been investigated by comparing postsystem with presystem trauma care with three methods: panel evaluation of preventable death rates, comparison of observed survival with expected probability of survival derived from large trauma registries, and evaluation of population-based general databases. These studies have demonstrated a decrease in preventable death rate and an increase in survival after system implementation. All these studies have been classified as providing weak class III evidence. However, with a large sample size and when properly designed, they generate important information regarding appropriateness of care delivered. Concentration of severely injured patients in trauma centers is associated with better outcomes. Population-based investigations provide the strongest evidence regarding effects of the trauma system on patient outcomes, other than survival outcome measures because long-term functional status may be more appropriate.

Isolated prehospital hypotension after traumatic injuries: a predictor of mortality?

In patients with traumatic injuries, prehospital hypotension that resolves by Emergency Department (ED) arrival is of uncertain significance. We examined the impact of prehospital hypotension (PH) in normotensive ED patients with traumatic injuries on predicting mortality and chest/abdominal operative intervention. A retrospective cohort study was conducted of consecutive patients undergoing helicopter transport to two trauma centers between 1993 and 1997. Outcomes were mortality and chest or abdominal operative intervention. Of 545 scene transports, 55 (10.1%) patients were hypotensive on ED arrival, leaving 490 normotensive ED patients. Of 490 patients, 35 (7%) had PH and 455 (93%) had no PH. Multiple logistic regression showed the PH group to have a relative risk for death of 4.4 (95% CI: 1.2–16.6, p < 0.03) and for chest or abdominal operative intervention of 2.9 (1.1–7.6, p < 0.03). In this study of normotensive trauma center patients, prehospital hypotension was associated with increased risk of mortality and significant chest or abdominal injury.

Cost of Treating Uninsured Jeopardizing Trauma Centers

Cost of Treating Uninsured Jeopardizing Trauma Centers

A longitudinal study of former trauma center patients: the association between toxicology status and subsequent injury mortality.

Despite the current emphasis on injury prevention, little has been done to incorporate alcohol intervention programs into the care of the injured patient. The purpose of this study was to determine whether patients admitted to a trauma center with positive toxicology findings (TOX+) have a higher subsequent injury mortality than those without such findings (TOX-). We followed a cohort of 27,399 trauma patients discharged alive between 1983 and 1995 to determine subsequent mortality. Death certificates were obtained to identify the cause of death. TOX+ patients had an injury mortality rate approximately twice that of the TOX- group (1.9% vs. 1.0%, p < 0.001). Overall, 22.7% of the deaths were due to injury; the TOX+ rate was 34.7% versus 15.4% for the TOX-. These data add strength to the premise that untreated substance abuse-related injury remains an untapped injury prevention opportunity.