Saturday, Apr 21, 2018
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Trauma by the numbers

One rule of thumb in medical care for patients is that, at least as far as your eyes, heart, brain, and a few other parts are concerned, you want to pick a surgeon who has done the procedure often.

A new study in the Journal of the American Medical Association suggests the same is true in cases of severe trauma, defined as having penetrating (bullet, knife, etc.) abdominal injury or multisystem blunt trauma (a head injury plus broken legs) typically seen in the worst auto accidents.

The results, with reservations, seemed particularly significant for abdominal injury patients in shock . Twelve of 20 of them died at low-volume trauma centers, four of 16 at the high-volume centers, researchers found. The survival rate among the blunt-trauma group in coma improved dramatically at trauma centers with the higher volumes, set by researchers at 650 patients a year.

The study heightens the need to discuss the kinds and numbers of high-level trauma centers communities should have and whether their development should have a regional flavor.

Washington state has only one trauma center. Toledo, by contrast, has three Level I trauma centers: Medical College of Ohio Hospital, St. Vincent-Mercy Medical Center, and Promedica's Toledo Hospital - more than any Ohio city.

The 650 number researchers thought ideal to ensure the best trauma care can be achieved only at centers in a few major population centers. The three local Level I centers say they meet the American College of Surgeons Committee on Trauma criteria.

It recommends that Level I trauma centers admit at least 1,200 trauma patients a year, 20 percent of them with highly severe injuries. Alternately, it said, a trauma surgeon should see more than 35 patients a year with very severe injuries. The three local trauma centers say they limit the number of trauma surgeons on call, so that those who serve can't get rusty. That's important.

Top-flight trauma centers are expensive, and so is the per capita cost of medical care in Toledo. Though it's comforting to know one is nearby, does the community need three? The market will eventually sort that out.

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