Highlevel trauma care may limit disability

The findings researchers say add to evidence that patients fare better when theyre treated under an organized trauma system where hospitals emergency services and state governments have coordinated plans for getting the right patients to the appropriate treatment

Socalled Level I trauma centers provide the most comprehensive care for traumatic injuries and have to meet certain requirements like having a specific number of surgeons and other specialists on duty 24 hours a day

Studies have found that for severely injured people getting care at a Level I trauma center can cut the risk of dying by 25 percent

But thered been some question about whether that drop in death rates might mean more people are surviving with severe disabilities according to Belinda J Gabbe the lead researcher on the study from Monash University in Melbourne

Our study shows that care at specialized trauma centers improves the chances of a better functional outcome that is less disability which really strengthens the evidence for organized trauma systems Gabbe told Reuters Health in an email

The study reported in the Annals of Surgery found that of nearly 5000 seriously injured patients treated in the state of Victorias trauma system those seen at a Level I center tended to be less severely disabled one year later

The sample included people whod been in a car or motorcycle accident or had suffered a fall with head chest or spinal cord injuries

Overall 35 percent of patients had a good recovery either back to their healthy selves or with some disruption to their daily activities and relationships

The odds of a better recovery were 22 percent higher for patients treated at Level I centers versus similar patients at other hospitals

Overall patients outlook also got better over time with generally lower levels of disability among patients treated in 20082009 versus 20062007

Gabbe said its not clear why that is

But she added it might be due to the maturing of the states trauma system

In the US about 45 million people live more than an hour away from a Level I or Level II trauma center by ambulance or helicopter according to the Centers for Disease Control and Prevention

Like Victoria where this study was done some US states have statewide trauma systems that aim to get the right patients to the right hospital as quickly as possible

But there are also countylevel systems

There are studies from San Diego Los Angeles Maryland and Milwaukee showing similar results as the current one said Dr Raul Coimbra who heads the division of trauma surgical critical care and burns at the University of California San Diego Health System

So the new findings are not novel according to Coimbra who was not involved in the study

But he said in an email the findings provide additional support to the concept that organized regionalized systems of care are effective in decreasing death and disability and provide high quality of care

Of course not all hospitals can or should be trauma centers Coimbra said In fact only a few should he noted

The goal then is to coordinate ambulance services hospitals and local governments to get severely injured patients to the right medical center as fast as possible and also to rehabilitation services for their injuries afterward

A significant amount of organization investment and effort is necessary to provide timely transport of a trauma patient to the most appropriate facility capable of taking care of severely injured patients Coimbra told Reuters Health

Right now he said there are California counties with some of the best regional trauma systems in the world

But California does not yet have a statewide system Coimbra noted and there are still areas of the state where people live far from any trauma center

The cost of setting up a statewide system is a major obstacle he said

Gabbe agreed that expense has been an issue in general when it comes to setting up trauma systems But their benefit is becoming clearer she said

There is strong evidence that organized trauma systems save lives and the evidence that they also reduce disability is growing Gabbe said They should be considered best practice for trauma care

Date : 11 May, 2012
Reference : www.reuters.com/article/2012/05/10/us-highlevel-traumacare-idUSBRE84910T20120510

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