Technology: The American medical Association says that, if you arrive in
the hospital emergency room alive, the probability that you will die from a
trauma wound today is half what it was just 10 years ago. I
presented this information in a paper to the annual convention of the AMA.
Although the steady progress in trauma work is not well know to the
general public, the point was not at all controversial to them. I would
politely and respectfully ask you to consider the possibility that you might
be mistaken in this matter."
Fabrice Czarnecki, MD, submits this:
I am looking for references (could not find
any so far supporting that statement). Even if Grossman had references, that
does not mean that intentional trauma might benefit from optimal medical care
(i.e., the perpetrator is unlikely to call EMS, and most urban victims of
gunshot wounds are themselves criminal or gang members, and might be unwilling
to go to the hospital and be reported to the Police).
See the reference below (trauma mortality did
not decrease by 50%).
Med Care 2001 Jul;39(7):643-53
Mortality among seriously injured patients treated in remote rural trauma
centers before and after implementation of a statewide trauma system.
Clay Mann N, Mullins RJ, Hedges JR, Rowland D, Arthur M, Zechnich AD.
Department of Emergency Medicine, University of Utah, School of Medicine, Salt
Lake City 84108-9161, USA. firstname.lastname@example.org
BACKGROUND: Injury mortality in rural regions remains high with little
evidence that trauma system implementation has benefited rural populations.
OBJECTIVE: To evaluate risk-adjusted mortality in remote regions of Oregon
before and after implementation of a statewide trauma system. RESEARCH DESIGN:
A retrospective cohort study assessing injury mortality through 30 days after
hospital discharge. SETTING: Nine rural Oregon hospitals serving counties with
populations <18 persons per square mile. SUBJECTS: Severely injured
patients presenting to four level-3 and five level-4 trauma hospitals 3 years
before and 3 years after trauma system implementation. MEASURES: Interhospital
transfer, hospital death, and demise within 30 days following hospital
discharge. RESULTS: A total of 940 patients were analyzed.
After trauma system implementation, patients
presenting to level-4 hospitals were more likely transferred to level-2
facilities (P <0.001). Interhospital transfer times from level-3 hospitals
lengthened significantly after system implementation (P <0.001). Overall
mortality rates were higher in the postsystem period (8.3%) than the presystem
period (6.7%), but not significantly. Controlling for covariates, no
additional benefit to risk-adjusted mortality was associated with trauma
system implementation. Additional deaths, occurring after trauma system
implementation, included head-injured patients transferred from rural
hospitals to nonlevel-1 trauma center hospitals. CONCLUSIONS: Increased injury
survival after Oregon trauma system implementation, demonstrated in urban and
statewide analyses, was not confirmed in remote regions of the state. Efforts
to improve trauma systems in rural areas should focus on the processes of care
for head-injured patients transferred to higher designation trauma centers.