Rate More Than Halved : Trauma Network Has Cut Deaths, County Study Says

San Diego County’s fledgling network of trauma care hospitals has dramatically decreased the percentage of people who die after suffering major injuries in this region, county health officials said Tuesday.

Figures compiled since patients began bypassing their nearest emergency rooms in favor of county-designated trauma centers show that the rates of both deaths and preventable deaths have decreased by large margins.

Those percentages, however, are based on relatively small samples and will need to be tested over a longer period of time, health department officials conceded at a news conference.

Among the findings of the study released Tuesday:

- The death rate for people who are accepted into the trauma care system has decreased from 26.4% to 10.5% since an outside study of the county’s emergency medical services was performed in 1982. In that study, 90 of the 341 patients whose cases were reviewed died. In the county’s study, which covered the five months between August and December, 1984, 111 of 1,061 patients died.

- When those deaths are reviewed, a certain number are determined to have been preventable, either because the trauma care system was inadequate or because errors in judgment or care were made by doctors. In the earlier study, 21.4% of the deaths were found to be preventable or potentially preventable. In the county study, 10% of the deaths fell into those categories.

- The number of patients who received questionable or inadequate care declined sharply. In the first study, 32% of the trauma patients were in that category, compared to just 2.6% in the most recent study.

The county’s trauma network began operations in August with five adult trauma centers and one at Children’s Hospital. Grossmont Hospital in La Mesa dropped out, and the Board of Supervisors added Palomar Hospital in Escondido. Other trauma centers are at UC San Diego Medical Center, Mercy Hospital, Scripps Memorial and Sharp Memorial.

James Forde, director of the county’s Department of Health Services, said Tuesday the results of the study made him feel like the coach of the Villanova University basketball team, which won the national collegiate championship Monday night.

“This community has a right to be proud of what we feel is the best trauma care system in the country,” Forde said. “We’re very encouraged by the data.”

What the study did not say was which of the county’s five adult trauma center hospitals should be dropped from the system and whether Oceanside’s Tri-City Hospital should be added. The county’s staff has already suggested that the network be trimmed from five to four hospitals, and Tri-City has operated as a trauma center without the county’s designation, in hopes of one day winning the official status.

Forde said those recommendations will come next week. The Board of Supervisors is scheduled to decide the issue April 16.

The report also failed to cite the areas in which the trauma network could be improved. Questioned by reporters, Forde and other officials offered these ideas:

- The number of patients taken to trauma centers but later found not to have needed the highly specialized and expensive care should be decreased. In the county’s study, 51% of the patients were found to have injuries not considered serious enough to require trauma center treatment. Half of those patients, however, would have been taken to the same hospital’s emergency room even had they not been diagnosed as trauma patients. That means that just over one-fourth of the patients are unnecessarily being taken to trauma centers farther from accident scenes than other fully equipped emergency rooms, a rate officials said they hope to lower even though they consider it acceptable.

- The county will reconsider its policy that requires “traumatic arrest” patients--people whose breathing and heartbeat have stopped--to be taken to their nearest emergency room rather than to a trauma center. Officials originally believed that those patients would be better served by receiving the quickest possible treatment even if it were not at a trauma center.

- Officials plan to take another look at whether anesthesiologists need to be at the hospital 24 hours a day with other specialists, as they are now, or should only be required to be available when patients are ready for surgery.

The report also provided some bits of information that were not crucial to the trauma network’s evaluation but seemed noteworthy nevertheless.

For example, the study found that the mean age of San Diego County trauma patients is 29 years, and that 82% of the victims are under 40 years old. Almost three out of four of the trauma patients are men.

Of children who were injured while passengers in cars or trucks, 95% would not have needed trauma care had they been restrained by a seat belt or child’s safety seat. In addition, 85% of the most seriously injured adult trauma patients taken to Tri-City Hospital after being involved in vehicle accidents had not been wearing seat belts.