July 13, 2007
Study: State Trauma System Improves Brain Injury Survival Rates
Iowans who suffer a traumatic brain injury (TBI) have a better chance of survival thanks to a statewide trauma system that was implemented in 2001, according to a study conducted by researchers from the University of Iowa Injury Prevention Research Center.
Receiving timely and specialized care is critical for patients with brain injuries, since secondary damage can occur during the hours following an injury. However, patients injured in rural areas often must travel farther and longer to reach specialized care facilities.
With the goals of reducing injury deaths, improving patient outcomes, and reducing medical care costs, the Iowa trauma system was established in 1995 through state legislation titled the Iowa Trauma System Care Development Act. The system was fully implemented statewide in January 2001. Features of the system include categorization and verification of each hospital, training in advanced trauma life support, definition of triage protocol, and uniform data definition and collection. Two Level I and seven Level II hospitals in the statewide system were required to have specialty coverage, including neurosurgery for traumatic injuries.
To examine how the implementation of Iowa's trauma system affected the triage and in-hospital death rates of brain-injured patients, the investigators analyzed data from the State Trauma Registry maintained by the Bureau of Emergency Medical Services in the Iowa Department of Public Health (IDPH). The researchers assessed TBI patient survival two years before the implementation of the trauma system (1997-1998) compared to two years after full implementation (2002-2003). The data included 710 pre-system patients and 886 post-system patients with moderate or severe head injury.
The study found that implementation of the trauma system was associated with a significant decreased risk of death overall -- and a nearly 50 percent decreased risk of death in the 72 hours following a TBI -- for both patients directly admitted to Level I and II hospitals and those transferred from local hospitals. The study appeared in the July 7 issue of the Journal of Neurotrauma and is available online at http://www.liebertonline.com/neu.
"Implementation of the Iowa trauma system has led to more appropriate triage and transport for TBI patients, and this likely contributed to reduced in-hospital mortality," said study co-author James Torner, Ph.D., UI professor of epidemiology. "The implication is that a system featuring categorization of hospitals based upon capabilities, educational standards for hospital staff, and triage protocols for transferring severely injured patients to comprehensive care trauma facilities saves lives."
"Iowans should be proud of the collaborative effort between IDPH, Iowa hospitals and EMS providers to develop this system that has now been proven to save lives," said Mary Jones, IDPH deputy director and head of the IDPH Division of Acute Disease Prevention and Emergency Response. "Special thanks should also go to all the physicians, nurses and paramedics dedicated to injury prevention and care in Iowa," she added.
In addition to Torner, the researchers included lead author Hope Tiesman, Ph.D., Tracy Young and Corinne Peek-Asa, Ph.D., all with the UI Injury Prevention Research Center; Mark McMahon at IDPH; and John Fiedler, IDPH state trauma system coordinator.
STORY SOURCE: University of Iowa College of Public Health Office of Communications, 4257 Westlawn, Iowa City, Iowa 52242.
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