Outcome of major trauma in a Turkish university hospital: did integrated approach make a difference?

The aim of this study was to determine the effect of the institution in an in-hospital integrated approach to trauma on the mortality of severely injured patients in a university hospital in Turkey. We examined the effects of several risk factors, namely physiological parameters, anatomical findings, and the timeliness of therapeutic approaches, on the mortality of major trauma patients before and after the institution of integrated trauma care. The investigated risk factors were injury severity score (ISS), revised trauma score (RTS), anatomical localization of the injury, the type of injury, prehospital time, emergency room time, and referral from another hospital. TRISS (RTS, ISS, and age combination index) analysis was done for each patient and the M-, Z-, and W-statistics were calculated. Mortality in the low RTS and the penetrating injury groups decreased significantly. The overall mortality decreased from 32.5% to 23.3%. There were three unexpected survivors in the second period, but there were no unexpected survivors in the first period. Twenty-six of the first period and nine of the second period deaths were unexpected. A significant improvement was seen in the Z-statistics between the two periods. Z value increased from -2.47 to 0.55. In-hospital integrated approach to trauma made major improvements in the care of the patients with severe injuries, especially those with significant airway, ventilation and circulation problems.

Financial burden of trauma care on a university hospital in a developing country.

BACKGROUND: Trauma care is expensive and more so for the hospitals not subsidized by the government, as is the case in developing countries. In this study, the burden of trauma care on a typical Level I trauma center in Turkey was investigated. METHODS: Medical, demographic, and financial records of trauma patients who were hospitalized in the calendar year of 1996 were analyzed. RESULTS: A total of 347 patients had complete data available for analysis. The mean Injury Severity Score was 13.3+/-0.5. Total hospital charges and charges per patient were $547,391 and $1,577, respectively. There was a positive correlation between the Injury Severity Score and the hospital charges. Although 54.2% of the patients were self-payer and the rest (45.8%) had some form of a health insurance, 5.5% ($30,496) of total hospital charges of these 347 trauma patients could not be collected by the hospital. CONCLUSION: Trauma care is expensive and reimbursement is not always possible, but the hospital's nonreimbursed money was within tolerable limits, and the overall financial balance of the hospital from the trauma care was on the positive side, even in the absence of government subsidy.