Binstead, Justin, DO

Fischer, Catherine, DO

Gerrald, Quincy, DO

Kane, Bryan G, MD

Sibley, Mary, DO

Vong, Kevin, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Emergency MedicineDoes Destination Determine Destiny? A StatewideAnalysis of Trauma Center MortalityBryan G. Kane MDLehigh Valley Health Network, bryan.kane@lvhn.orgQuincy Gerrald DOLehigh Valley Health NetworkCatherine Fischer DOLehigh Valley Health Network, Catherine_B.Fischer@lvhn.orgKevin Vong DOLehigh Valley Health NetworkMary Sibley DOLehigh Valley Health NetworkSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/emergency-medicinePart of the Emergency Medicine Commons, Statistics and Probability Commons, and theTrauma CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKane, B., Gerrald, Q., Fischer, C., Vong, K., Sibley, M., & Binstead, J. (2014, February 22). Does destination determine destiny? Astatewide analysis of trauma center mortality. Poster presented at: The 2014 Society of Academic Emergency Medicine (SAEM) Mid-Atlantic Regional Meeting, Philadelphia, PA.Poster presented at: The PaACEP Scientific Assembly, Harrisburg, PA. (April 7-9, 2014).AuthorsBryan G. Kane MD, Quincy Gerrald DO, Catherine Fischer DO, Kevin Vong DO, Mary Sibley DO, and JustinBinstead DOThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/emergency-medicine/251Lehigh Valley Health Network, Allentown, PennsylvaniaDoes Destination Determine Destiny? A Statewide Analysis of Trauma Center MortalityBryan G. Kane, MD, Quincy Gerrald, DO, Catherine Fischer, DO, Kevin Vong, DO, Mary Sibley, DO, Justin Binstead, DOBackground:© 2014 Lehigh Valley Health NetworkExcellent trauma care relies on an excellent trauma system. In a standardized trauma system, patient outcomes would be based on severity of injury, rather than presenting hospital.  Objectives:In this study, we sought to determine the relationship between severity of presentation of patients and their outcome as measured by mortality or transfer to another institution at trauma centers throughout the State of Pennsylvania (PA).Methods:After IRB approval, data were gathered about PA trauma centers from the Pennsylvania State Trauma Systems Foundation (PTSF). Anonymous data from each of the state’s 32 certified trauma centers as they relate to mortality, transfer and Injury Severity Score (ISS) score were gathered. ISS scores were reported as the institutional average. Included in the analysis were adult patients. Excluded were pediatric trauma patients. The analyzed cohort was for the calendar year 2008. Smoothed Lowess curves were used to determine relationships.Results:In 2008, there was a total of 31,612 trauma-activated adult patients in PA. Of these cases, 95.5% (n=30,197) were admitted to the hospital at which they were initially seen, 3.0% (n=960) were transferred to another institution, and 1.4% (n=450) died in the Emergency Department. Analysis by institutional ISS score and total number of transfers from any one institution found no relationship. When controlling for the volume of trauma at the presenting institution, it was determined that the six lowest trauma volume institutions in PA transferred the greatest proportion of their patients despite having the lowest average ISS scores. When accounting for these six lowest ISS score institutions, Figure 1 represents the lack of a clear relationship between ISS score and institutional mortality. There is no relationship between institutional ISS scores and their proportion of patients admitted. Mortality appears to be institution-specific.Conclusion:In this retrospective analysis of data reported to a state-wide trauma certification agency in PA, the overwhelming majority of patients receive all of their care (96.9%) at the institution to which they present. As measured by ISS, mortality appears to be linked to the institution rather than injury severity. Low volume trauma centers appear to transfer the greatest proportion of their patients despite low ISS.Figure 1.  Scatterplot of Injury Severity Score (ISS) and patients who died at the institution with smoothed Lowess curve.InjurySeverityScore(ISS)5040302010Cases Who Died in Emergency Department (n)00246810121416182060 70Funding: Funding for this project was provided, in part, by a PCOM MEDNet unrestricted research grant.

Does Destination Determine Destiny? A Statewide Analysis of Trauma Center Mortality

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1250&context=emergency-medicine

Does Destination Determine Destiny? A Statewide Analysis of Trauma Center Mortality

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