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Admission Patterns of an Urban Level I Trauma Center

Department of Surgery, Jefferson Medical College, Philadelphia, Pa, and Section of Trauma and Surgical Critical Care, Yale University School of Medicine, New Haven, Conn

Damian Szewczyk, MD

Department of Surgery, Jefferson Medical College, Philadelphia, Pa, and Section of Trauma and Surgical Critical Care, Yale University School of Medicine, New Haven, Conn

Kathy Walker, RN

Department of Surgery, Jefferson Medical College, Philadelphia, Pa, and Section of Trauma and Surgical Critical Care, Yale University School of Medicine, New Haven, Conn

Fizan Abdullah, MD, PhD

Department of Surgery, Jefferson Medical College, Philadelphia, Pa, and Section of Trauma and Surgical Critical Care, Yale University School of Medicine, New Haven, Conn

Susan Schmidt-Gillespie, RN, BSN

Department of Surgery, Jefferson Medical College, Philadelphia, Pa, and Section of Trauma and Surgical Critical Care, Yale University School of Medicine, New Haven, Conn

Reuven Rabinovici, MD, FACS

Department of Surgery, Jefferson Medical College, Philadelphia, Pa, and Section of Trauma and Surgical Critical Care, Yale University School of Medicine, New Haven, Conn, reuven.rabinovici{at}yale.edu

Because trauma admission and hospitalization patterns have profound effects on the organization and utilization of urban trauma-care systems, the objective of this study was to identify and analyze these patterns. As an example, admissions to an urban Level I trauma center were reviewed. Retrospective review of all 2029 trauma admissions to a Level I trauma center was conducted from 1993 to 1996. The result was that most trauma patients were young (40% <30 years of age) and male (74%). Mechanisms of injury were motor vehicle accident (36%), fall (27%), gunshot (17%), stab (7%), assault (6%), and swimming or diving accident (3%). Half of the patients were directly admitted from the scene. Injury Severity Score, length of stay, and mortality were 14.1 ± 0.3, 10.5 ± 0.3 days, and 5.1%, respectively. Admissions tended to occur more frequently between 4:00 PM and midnight (46%), between Friday and Sunday (52%), and between July and October (41%). The following patterns were identified: admissions per year decreased (-21%) because of reduced penetrating trauma (-43%, P < .01); pediatric patients (<15 years) had similar incidence of penetrating trauma as adults (ages 15-45). Length of stay for all mechanisms of injury was not statistically different; most mortalities occurred within the first day (33%, P < .01) or after 6 days (36%, P < .01); early mortality was mainly due to penetrating injury (74%, P < .01), whereas late mortality was related to blunt trauma (92%, P < .01). The conclusion was that admission and demographic patterns were identified, which may be useful in the utilization, modification, and future design of trauma systems.

Key Words: Admissions • trauma • urban

American Journal of Medical Quality, Vol. 15, No. 1, 9-15 (2000)
DOI: 10.1177/106286060001500103


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