000			02535cam a2200265 4500
100	1		_aCHIU William C
700			_aPOWERS D B
700			_aHIRSHON J M
245			_aImpact of trauma centre capacity and volume on the mortality risk of incoming new admissions/ _cWilliam C Chiu, D B Powers, J M Hirshon et.al
260			_c2022
520			_aIntroduction: Trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions.
520			_aMethods: For a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression.
520			_aResults: There were 42003 (mean=7000/year) admissions having complete data sets, with 36354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p<0.05). When TRU occupancy reached ≥16 patients, the factors associated with increased NEW admission hospital mortality were existing patients (TRU >1hour) with SI ≥0.9, recent admissions (TRU ≤1hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p<0.05).
520			_aConclusion: The mortality of incoming patients is not impacted by routine trauma centre overcapacity. In conditions of severe overcrowding, the number of admitted patients with shock physiology and a recent surge of elderly/debilitated patients may influence the mortality risk of a new trauma admission.
650			_aTRAUMA CARE _xTIME-CRITICAL ASSESSMENTS
650			_aTRAUMA SYSTEMS _xCRITICAL INJURED
650			_aTRAUMA CENTRE CAPACITY _XSURGE VOLUME
650			_aGLASGOW COMA SCALE _XSHOCK INDEX
650			_aMORTALITY INCOMING PATIENTS
650			_aMILITARY _xHEALTH
773			_aBMJ Military Health: _gVol.168, Iss.3, June 2022, pp.212-217 (37)
598			_aMILITARY, HEALTH
856			_uhttps://militaryhealth.bmj.com/content/168/3/212 _zClick here for more
945			_i67738.1001 _rY _sY
999			_c41739 _d41739