Geriatric motor vehicle collision survival: the role of institutional trauma volume.

BACKGROUND: Links between trauma center volumes and outcomes have been inconsistent in previous studies. This study examines the role of institutional trauma volume parameters in geriatric motor vehicle collision (MVC) survival. METHODS: The New York Statewide Planning and Research Cooperative Systems database was analyzed for all trauma admissions to state-designated Level I and II trauma centers from 1996 to 2003. For each center, the volume of patients was calculated in each of the following four categories: Young adult (age, 17-64 years) MVC and non-MVC, and geriatric (65 years and older) MVC and non-MVC. Logistic regression analysis was used to predict patient survival to hospital discharge based on the four volume parameters of the center at which they were treated, age, gender, ICISS, year of admission, and type of center. RESULTS: Five thousand three hundred sixty-five geriatric MVC victims were admitted to Level I (n = 3,541) or II (n = 1,824) centers in New York State excluding New York City. Four thousand eight hundred ninety-eight (91%) patients were discharged alive. Volume of geriatric MVC at the center at which the patient was treated was an independent significant predictor of survival (odds ratio, 32.6; 95% confidence interval, 2.8-377.0; p = 0.005) as were younger age, female gender, increased ICISS, and later year of discharge. Young adult non-MVC volume was an independent significant predictor of nonsurvival of geriatric patients (odds ratio, 0.8; 95% confidence interval, 0.64-0.99; p = 0.042). Type of center was unrelated to outcome. CONCLUSIONS: There may be a risk-adjusted survival advantage for geriatric MVC patients treated at trauma centers with relatively higher volumes of geriatric MVC trauma and lower volumes of young adult non-MVC trauma. These results support consideration of age in trauma center transfer criteria.

Determinants of family satisfaction in the intensive care unit.

The aim of this study was to explore the degree and determinants of satisfaction of family members of patients being cared for in an Australasian intensive care unit. This was a prospective observational study that took place within a mixed medical/surgical, level three intensive care unit. One hundred and eight family members of patients staying in the intensive care for more than 48 hours were identified. Eight were excluded because next of kin contact details were unavailable. A questionnaire was posted to next of kin four weeks after intensive care unit discharge. Subjects who had not responded after four weeks were contacted by telephone and, if consent was given, a phone questionnaire was performed. Evidence of family meetings with the social worker or medical staff was sought in the patients' case notes retrospectively. Family satisfaction was measured using a 10-item questionnaire incorporating visual analogue scales. Seven subjects refused to participate. Fifty-nine responded by post and a further 25 agreed to a phone interview. Nine subjects were unable to be contacted. Eighty-four family members were included, 73 of patients who survived. Overall family satisfaction was a high 8.0 (interquartile range 6.5 to 9.5). Highest scores recorded were for communications with nursing staff (9.0), while lowest scores were for frequency of doctors' communication (7.0). Families who had meetings with the social worker or medical staff were less likely to report dissatisfaction (relative risk 0.14; confidence interval 0.03 to 0.59; P=0.08; relative risk 0.23; confidence interval 0.07 to 0.81; P=0.02). Our study found that the majority of families are happy with their care in the intensive care unit. Social work and medical meetings with the family reduce dissatisfaction.