The use of a database relies on the quality of input, which may include inaccurate data or inaccurate data entry. This study has some limitations, including the inherent flaws of any retrospective study.
/cdn.vox-cdn.com/uploads/chorus_image/image/63485913/trauma_bay.0.jpeg "level 1 trauma")
Level 1 trauma code#
Therefore, if any of these are found upon the prehospital assessment the likelihood of unstable pelvic fracture is high and could potentially be investigated for its utility as part of the criteria for level 1 trauma code assignment. While these findings are not highly sensitive, they are specific for pelvic fractures - particularly unstable fractures. Instability to pelvic ring compression had a sensitivity and specificity of 0.08 (95%CI: 0.04-0.14) and 0.99 (95%CI: 0.99-1.0), respectively, for detection of any pelvic fracture and 0.26 (95%CI: 0.15-0.43) and 0.999 (95%CI: 0.99-1.0), respectively, for detection of mechanically unstable pelvic fractures. The sensitivity and specificity of the presence of pelvic deformity were 0.30 (95%CI: 0.22-0.39) and 0.98 (95%CI: 0.98-0.99), respectively for detection of any pelvic fracture and 0.55 (95%CI: 0.38-0.70) and 0.97 (95%CI: 0.96-0.98), respectively for detection of mechanically unstable pelvic fractures. Their approach was effective in identifying patients with potentially serious injuries as all evaluated indicators of severe injury (including intubation, transfer to ICU or OR, and death) were significantly different between the level 1 and level 2 group ( P 13 were 0.74 (95%CI: 0.64-0.82) and 0.97 (95%CI: 0.96-0.98), respectively for diagnosing any pelvic fractures, and 1.0 (95%CI: 0.85-1.0) and 0.93 (95%CI: 0.92-0.95), respectively for diagnosing mechanically unstable pelvic fractures. Kouzminova et al, evaluated a two-tiered trauma activation system based on ACS field trauma center triage criteria. Although there are guidelines set by the American College of Surgeons (ACS), each institution modifies these guidelines for their own environment and patient population. The criteria used to determine trauma code status is not consistent across institutions. For those with unstable pelvic fractures ( n = 85), assignment of a level 2 trauma code was associated with reduced odds of death (OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being dispatched to home, with a trend towards reduced odds of being dispatched to a rehabilitation center as well (OR = 0.43, 95%CI: 0.16-1.17, P = 0.099). For those with stable pelvic fractures ( n = 153), assignment of a level 2 trauma code was associated with reduced odds of death (OR = 0.10, 95%CI: 0.03-0.33, P < 0.0001) or being dispatched to a rehabilitation center (OR = 0.21, 95%CI: 0.10-0.47, P < 0.0001) as compared to being dispatched to home. For all participants ( n = 238), assignment of a level 2 trauma code was associated with reduced odds of death (OR = 0.09, 95%CI: 0.03-0.23, P < 0.0001) or being dispatched to a rehabilitation center (OR = 0.29, 95%CI: 0.16-0.53, P < 0.0001) as compared to being dispatched to home.
There is an association between trauma code level and patient discharge status with higher rates of mortality in level 1 trauma activation (28 deaths in the level 1 group and 6 in the level 2 group). Our secondary purpose was to compare post-hospital disposition associated with pelvis fractures for level 1 and 2 trauma codes to determine if the trauma code status correlated with different outcomes for these injuries.Īssignment of a level 1 trauma code was not associated with odds of having an unstable fracture (OR = 0.83, 95%CI: 0.48-1.41, P = 0.485) ( n = 238). Specifically, our hypothesis was that unstable pelvic ring injuries would have a higher association with level 1 trauma code status due to the hemodynamic compromise often seen with these severe injuries. Our primary purpose was to determine if there is any association between trauma code level and the severity of pelvic ring injuries. Pelvic ring injuries are associated with a high rate of morbidity, with a short-term complication rate ranging from 50%-80%, and a high rate of mortality of over 8%. Criteria that are commonly used include hypotension in the field, truncal gunshot wounds, field Glasgow coma scale (GCS) 70. Specific field criteria for a level 1 designation have been previously investigated.
The determination of trauma code criteria varies between hospitals and is based on elements such as physiologic data, types of injury, and mechanism of injury. Patients with the most serious injuries are designated a level 1 trauma, indicating a need for a larger trauma team and faster response time. The composition of the trauma team and the urgency of the trauma response can then be tailored to meet the needs of the patient based on the trauma code level. At all accredited trauma centers, patients are triaged into a level 1 or level 2 trauma code based on specific criteria.
0 kommentar(er)
