78.15 Characterization of Injury Rates by Population Density in Florida

Posted on January 18, 2016

A. Lai1, D. Kim1, C. Kapsalis1, D. Ciesla1 1University Of South Florida College Of Medicine,Tampa, FL, USA

Introduction:
Traumatic injuries are the third leading cause of mortality amongst Americans. Injury mechanisms can be separated into individual events (e.g. falls) or interaction events (e.g. motor-vehicle accidents). Interaction events occur between individuals and are expected to be higher amongst regions with higher population density. We aimed to see whether collisions mechanisms in Florida counties increased with population density.

Methods:
Data for this retrospective cohort study were obtained from the 2013 Florida Agency for Healthcare Administration (AHCA) discharge database. All patients with trauma alert charges or admission type defined as trauma were included. Additionally, any admissions classified as urgent or emergent with any ICD-9 codes between 800 and 957 were included. Patients were excluded if they were pronounced dead on arrival. County populations were taken from the 2013 Census Data estimates, and county-level characteristics were taken from 2010 Census Data estimates.

Results:

Age-adjusted population density was not a significant predictor of low-energy mechanisms (p=0.1063); however, median county age was a significant predictor in the model (p=0.0340). The model was a significant (p=0.0173). Age-adjusted population density was not a significant predictor of high-energy mechanisms (p=0.8271). Median age was not a significant predictor (p=0.8218), and the model was not significant (0.9433).

Conclusion:
Both low-energy and high-energy mechanisms do not appear to be linearly correlated with population density after adjustment for median county age. The data suggest that both trauma mechanisms appear to occur independent of population density in Florida.

76.14 Variability in Trauma Center Patient Demographics: One Level Fits All?

Posted on January 18, 2016

C. Kapsalis1, A. Lai1, D. Kim1, D. Ciesla1 1University Of South Florida College Of Medicine,Tampa, FL, USA

Introduction:
Trauma center standards define the resources and processes that best meet the needs of injured patients. The regional trauma system aims to match the distribution and level of designated trauma centers to meet the needs of its population. Population demographics vary substantially across regions and predict variation in trauma center demographics. The purpose of this study was to characterize the variation in Florida trauma center patient populations.

Methods:
A statewide discharge dataset was queried for all injury related discharges from Florida acute care hospitals using ICD-9 codes in 2014. Hospitals were categorized as non-trauma centers (NTC), Level 2 (DTC2), pediatric Level 2 (DTC2p), and Level I (DTC1) Designated trauma centers. Elderly patients with isolated hip fractures from falls were excluded. ICISS values were calculated for all ages based on survival risk ratios of the adult (age 16-65) age group for the 5 years preceding the reported year. An ICISS <0.85 defined high mortality risk and predicts <85% survival.

Results:
There were 133710 injured patients discharged from 211 Florida acute care hospitals in 2014; 54,478 (41%) from one of 24 designated trauma centers including 10226 (80%) of 12771 high-risk patients. Individual trauma center volumes are shown in the figure. Although there was variability within each group, DTC1’s as a group had a higher proportion of high risk patients (22%) compared to DTC2p (16%) and DTC2 (17%), lower proportion of elderly patients (26%) compared to DTC2p (42%) and DTC2 (43%), and a lower proportion of injuries resulting from falls (35%) compared to DTC2p (48%) and DTC2 (47%). Among the high risk patients, DTC1 treated a lower proportion of patients with Traumatic brain injuries (19%) compared to DTC2p (23) and DTC2 (28%).

Conclusion:
Although all trauma centers may meet level specific standards and serve distinct populations, there is significant variability in populations served among Level 1 and Level 2 trauma centers and substantial overlap between some Level 1 and Level 2 centers. This information is useful in trauma systems planning when designating trauma centers within specific regions.

15.05 Trauma Resuscitation Teams Add Little to the Initial Treatment of Ground Level Falls

Posted on January 18, 2016

D. Kim1, A. Lai1, S. Lorch1, C. Kapsalis1, D. Ciesla1 1University Of South Florida College Of Medicine,Tampa, FL, USA

Introduction:
The trauma resuscitation team (TRT) adds to the care of the injured by performing immediately life saving interventions, completing the diagnostic workup, and planning definitive care. Triage guidelines target TRT activation to those patients who are at high risk of severe injury. Ground level fall (GLF) is the most common mechanism associated with injury related hospital discharges. Although GLF is a low energy transfer mechanism, patients often present with physiologic findings that trigger TRT activation. The purpose of this study was to measure the need for life saving interventions in patients presenting after ground level falls.

Methods:
We queried our institutional trauma registry for all patients presenting after ground level fall from 2012-2014. Records were reviewed to determine the number of life saving interventions that occurred during the initial treatment phase. Life saving interventions were defined as CPR, intubation, chest tube placement, central line placement, packed red blood cell transfusion and transfer directly to the OR. Patients were grouped according to TRT Activation (full), Alert (partial), consult or none.

Results:

We identified 1398 patients who suffered ground level falls. Only 0.1% of patients underwent CPR in the ER. Intubation was required in 4.2% of all patients. Of the 59 patients that required intubation, 36 were intubated in the pre-hospital setting. Other life saving interventions included chest tube placement in 0.5% of patients, central line placement in 0.8% of patients, packed red blood cell transfusion in 1.1% of patients and transfer directly to the OR in 5.4% of patients.

Of those who were transferred directly to the OR, 12 required decompressive craniotomies. Operative fixation of fractures occurred in 55 patients. Laminectomy with fusion was required in 2 patients. Ophthalmic injuries necessitating operative intervention occurred in 7 patients. No patients required a trauma laparotomy.

Conclusion:
The main value of a trauma team is to perform life saving interventions and to approach the injured patient in an organized fashion. Patients who suffer from ground level falls rarely require life saving interventions. Trauma triage is a dynamic process. In a setting where patients can be rapidly evaluated and their triage upgraded at any time, the best use of resources may be to forgo pre-hospital trauma team activation for the ground level falls.