QUALITY OF TREATMENT OF TRAUMA PATIENT A COMPARATIVE STUDY

(REVISED) CELE ORGANISING FRAMEWORK ON EVALUATING QUALITY IN EDUCATIONAL
ANNUAL DRINKING WATER QUALITY REPORT FOR 2018 WESTFIELD
EQUALITY MONITORING FORM WHY WE NEED THIS

QUALITY AND CHARACTER ORIENTED SCHOOL PEMERINTAH PROVINSI
SHARING OUR THOUGHTS ON QUALITY EDUCATION
(DRAFT 2704) PRESCHOOL EDUCATION THE QUALITY OF EDUCATIONAL PROVISION

Quality of Treatment of Trauma Patient

Quality of Treatment of Trauma Patient. A comparative study of the trauma data of Hadassah Ein-Kerem and 51 trauma level I hospitals in the USA.

Project participants: Dr. Yoav Mintz, Prof. Avraham Rivkind and Dr. Rony Braunstein





Background: In Israel, Hadassah and five other hospitals have trauma centers defined as level-I because of their expertise and capacity to handle trauma injuries of all kind. The current study compares survival at Hadassah to those in level I trauma hospitals in the USA.

Methods: Data on trauma patients at Hadassah derives from the Israeli national trauma registry system, including a total of 7,391 patients, and operated by the Gertner institute for epidemiology and health policy in Israel. U.S. data on trauma patients derives the National Trauma Data Bank (NTDB) of the American College of Surgeons Committee on Trauma, covering 51 level-I trauma centers, including a total of 263,524 patients. The timeframe is from year 1999 thru 2003.

Results: The major outcome, the average rate of death, was 2.6% at Hadassah compared to 5.8% in the USA. Mortality rates were also compared stratified according to the gravity of trauma, estimated by the Injury Severity Scale (ISS) and the analysis is shown in Figure 1 below.

QUALITY OF TREATMENT OF TRAUMA PATIENT A COMPARATIVE STUDY


From Figure 1, it appears that for each sub-group of injury severity, the death rate at Hadassah is lower than the mean death rate in the U.S. (NTDB) data.

AQUALITY OF TREATMENT OF TRAUMA PATIENT A COMPARATIVE STUDY
similar finding can be noticed when one examines the death rate by Injury Mechanism (IM). For most types of injury mechanism, as shown in Figure 2 below, the death rate at Hadassah appears lower than the mean death rate in the U.S. (NTDB) data (only in the category of cuts and stabs is the death rate in Hadassah higher (1.0%) than the average death rate (0.6%) of the NTDB data).

As shown in Figure 3 below,QUALITY OF TREATMENT OF TRAUMA PATIENT A COMPARATIVE STUDY
for each year from 1999 to 2003, the death rate at Hadassah (triangles) appears is lower than the average death rate of the U.S. (NTDB) data (circles). This conclusion holds both for total mortality (shown in closed symbols) and for the mortality of most severe patients (defined as having an injury score over 16, ISS 16+, shown in open symbols).



Conclusion and future plans: Hadassah appears to have an overall lower death rate (2.6%) than 51 U.S. level-I trauma centers (where the death rate is 5.8%). If improved survival at Hadassah is related to higher performance, such quality applied to the 263,524 patients in the US trauma centers, would have prevented about 8,400 deaths.

The data were sent for review to Prof. Ellen J. MacKenzie, Ph.D., Director, Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health. She replied: “The data you sent on is most interesting! You must be doing something right at Hadassah!”. Attempts will be made to further analyze these data by adjustments for confounding factors and alternate modeling,1 and to focus our comparison with the most experienced units in the U.S. A possible reason for improved performance at Hadassah could relate, at least in part, to the general availability of senior trauma, orthopedic and other specialty surgeons at critical times, during evening and night shifts, while similar cases would often be handled, in the U.S, by residents and non-specialist surgeons.


1 Frankema SPG, Steyerberg EW, Edwards MJR, van Vugt AB. Comparison of Current Injury Scales for Survival Chance Estimation: An Evaluation Comparing the Predictive Performance of the ISS, NISS, and AP Scores in a Dutch Local Trauma Registration. Journal of Trauma-Injury Infection & Critical Care March. 2005;58(3):596-604.


(INE)QUALITY STREET DO YOU OR DOES YOUR PARENT(S)
05 PROMOTING INCLUSION EQUALITY AND VALUING DIVERSITY POLICY ALONGSIDE
1 QUALITY ASSESSMENT FIGURE S1 RISK OF BIAS ASSESSMENT


Tags: comparative study, comparative, trauma, quality, treatment, patient, study