The Journal of Trauma: Injury, Infection, and Critical Care · 1986 · 339 citations · 0 references
MedicineEmergency MedicinePediatricsPediatric Emergency CareResuscitationTrauma CarePediatric TraumaTrauma AssessmentTrauma ResuscitationTrauma SurgeryTrauma TriageBlunt Trauma CarePediatric Trauma ManagementPreventable MortalityTrauma Data CollectionTrauma Outcomes AssessmentTrauma System DesignTrauma System EvaluationTrauma System Organization
The study aimed to determine whether San Diego County required a formal trauma system by conducting a concurrent audit of trauma care in 1982. Researchers audited 591 major trauma victims from March to June 1982 and 1,366 victims from August to December 1984, using a monthly concurrent audit by a Medical Audit Committee to assess timeliness, appropriateness of diagnosis and definitive care, and classify deaths as preventable, potentially salvageable, or not preventable. After regionalization, suboptimal care fell from 32 % to 4.2 % and preventable deaths dropped from 13.6 % to 2.7 %, demonstrating a significant improvement in trauma outcomes.
To assess the need for a trauma system in San Diego County, a concurrent audit of trauma care was performed by an independent consultant in 1982. During the study period from 15 March through 15 June 1982, 591 consecutive major trauma victims (MTV) were collected by the 30 participating hospitals. All medical records, including autopsy reports, were audited for the timeliness and appropriateness of diagnosis and definitive care. Deaths were classified as being not preventable, potentially salvageable, or preventable. A trauma system subsequently became functional on 1 August 1984, with five adult centers and one pediatric center. A Medical Audit Committee composed of physicians and nurses from designated and nondesignated hospitals was organized to perform a monthly concurrent audit of trauma care. Between 1 August and 31 December 1984, 1,366 MTV were triaged to trauma centers. The care of MTV was considered suboptimal in 32% of patients before regionalization, compared to 4.2% after regionalization (p<0.01). Preventable deaths occurred in 13.6% of fatalities occurring before implementation of a trauma system, compared to 2.7% after implementation (p<0.01). Regionalization of trauma care significantly reduced delays, inadequate care, and preventable deaths due to trauma.