Citation

Cuschieri J, Johnson JL, Sperry J, West MA, Moore EE, Minei JP, Bankey PE, Nathens AB, Cuenca AG, Efron PA, Hennessy L, Xiao W, Mindrinos MN, McDonald-Smith GP, Mason PH, Billiar TR, Schoenfeld DA, Warren HS, Cobb JP, Moldawer LL, Davis RW, Maier RV, Tompkins RG. Ann. Surg. 2012; 255(5): 993-999.

Affiliation

*University of Washington School of Medicine and Harborview Medical Center, Seattle, WA †University of Colorado Health Sciences Center and Denver Health Medical Center, Denver, CO ‡University of Pittsburgh Medical Center and Presbyterian University Hospital, Pittsburgh, PA §University of California San Francisco and San Francisco General Hospital, San Francisco, CA ‖University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas ¶University of Rochester Medical Center and Strong Memorial Hospital, Rochester, NY #University of Toronto and St Michael's Hospital, Toronto, Ontario, Canada **University of Florida College of Medicine and Shands Hospital, Gainesville, FL ††Harborview Medical Center, Seattle, WA ‡‡Massachusetts General Hospital, Boston, MA §§Stanford Genome Technology Center, Palo Alto, CA ‖‖Harvard Medical School and Massachusetts General Hospital, Boston, MA.

Copyright

(Copyright © 2012, Lippincott Williams and Wilkins)

DOI

10.1097/SLA.0b013e31824f1ebc

PMID

22470077

PMCID

PMC3327791

Abstract

OBJECTIVE:: To determine and compare outcomes with accepted benchmarks in trauma care at 7 academic level I trauma centers in which patients were treated on the basis of a series of standard operating procedures (SOPs). BACKGROUND:: Injury remains the leading cause of death for those younger than 45 years. This study describes the baseline patient characteristics and well-defined outcomes of persons hospitalized in the United States for severe blunt trauma. METHODS:: We followed 1637 trauma patients from 2003 to 2009 up to 28 hospital days using SOPs developed at the onset of the study. An extensive database on patient and injury characteristics, clinical treatment, and outcomes was created. These data were compared with existing trauma benchmarks. RESULTS:: The study patients were critically injured and were in shock. SOP compliance improved 10% to 40% during the study period. Multiple organ failure and mortality rates were 34.8% and 16.7%, respectively. Time to recovery, defined as the time until the patient was free of organ failure for at least 2 consecutive days, was developed as a new outcome measure. There was a reduction in mortality rate in the cohort during the study that cannot be explained by changes in the patient population. CONCLUSIONS:: This study provides the current benchmark and the overall positive effect of implementing SOPs for severely injured patients. Over the course of the study, there were improvements in morbidity and mortality rates and increasing compliance with SOPs. Mortality was surprisingly low, given the degree of injury, and improved over the duration of the study, which correlated with improved SOP compliance.

Language: en