PMID- 24074427
OWN - NLM
STAT- MEDLINE
DCOM- 20131126
LR  - 20130930
IS  - 1532-7361 (Electronic)
IS  - 0039-6060 (Linking)
VI  - 154
IP  - 4
DP  - 2013 Oct
TI  - Regional collaboration across hospital systems to develop and implement trauma 
      protocols saves lives within 2 years.
PG  - 875-82; discussion 882-4
LID - S0039-6060(13)00415-7 [pii]
LID - 10.1016/j.surg.2013.07.013 [doi]
AB  - BACKGROUND: The Northern Ohio Trauma System (NOTS) was created with the expressed 
      goal of improving trauma care through collaboration, system-wide protocol 
      implementation, and evidence-based process improvement. The primary goal of this 
      study was to evaluate the mortality of trauma patients seen across the region 
      after 2 years of beginning NOTS. METHODS: Regional data was compared with the 2 
      years pre-NOTS (2008 and 2009) to the 2 years post-NOTS (2010 and 2011). The 
      regional system consisted of two large hospital systems, initially including one 
      level 1 center, four level 2 centers, seven nontrauma hospitals, and local 
      emergency medical services groups. Two level 2 trauma centers closed during the 
      study period. Mortality was the primary outcome for this study. Multivariate 
      logistic regression also was performed to evaluate for independent predictors of 
      mortality. An odds ratio (OR) and 95% confidence interval (CI) of survival were 
      determined after we adjusted for other factors associated with mortality. RESULT: 
      During the 4-year period 29,890 trauma patients were seen throughout NOTS. The 
      mean age was 44 with a mean Injury Severity Score (ISS) of 8; 65% of the patients 
      were male. Racial breakdown demonstrated that 64.0% were white, 31.9% were black, 
      and 4.1% were other races. The hospital stay (mean +/- SD) was 3.0 +/- 5.2 days, and 
      overall mortality was 3.4%. A separate analysis in which we used multivariate 
      logistic regression demonstrated that patients treated in the post-NOTS period 
      was an independent predictor for survival when we controlled for age, sex, 
      ethnicity, mechanism, and ISS. The OR of survival of post NOTS was 0.81 (95% CI 
      0.70-0.94) when we evaluated all patients. The OR for admitted patients was 0.79 
      (95% CI 0.67-0.94) and 0.76 (0.62-0.95) in patients with ISS > 24. There was an 
      increase in the percentage of patients seen at the level 1 center in the 
      post-NOTS period, which was especially demonstrated in patients with greater ISS. 
      CONCLUSION: NOTS appears to have contributed to the saving of lives within 2 
      years of its formation. Regionalized protocols, collaboration, and consolidation 
      resulted in an improvement in mortality.
CI  - Copyright (c) 2013 Mosby, Inc. All rights reserved.
FAU - Claridge, Jeffrey A
AU  - Claridge JA
AD  - Department of Surgery, Case Western Reserve University School of Medicine, 
      Cleveland, OH. Electronic address: jclaridge@metrohealth.org.
FAU - Allen, Debra
AU  - Allen D
FAU - Patterson, Brendan
AU  - Patterson B
FAU - DeGrandis, Fred
AU  - DeGrandis F
FAU - Emerman, Charles
AU  - Emerman C
FAU - Bronson, David
AU  - Bronson D
FAU - Connors, Alfred
AU  - Connors A
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cooperative Behavior
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Injury Severity Score
MH  - Length of Stay
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - *Trauma Centers
MH  - Wounds and Injuries/*mortality/therapy
EDAT- 2013/10/01 06:00
MHDA- 2013/12/16 06:00
CRDT- 2013/10/01 06:00
PHST- 2013/03/08 00:00 [received]
PHST- 2013/07/15 00:00 [accepted]
PHST- 2013/10/01 06:00 [entrez]
PHST- 2013/10/01 06:00 [pubmed]
PHST- 2013/12/16 06:00 [medline]
AID - S0039-6060(13)00415-7 [pii]
AID - 10.1016/j.surg.2013.07.013 [doi]
PST - ppublish
SO  - Surgery. 2013 Oct;154(4):875-82; discussion 882-4. doi: 
      10.1016/j.surg.2013.07.013.