Trauma Deaths Drop Sharply at County-USC

The rate of trauma-related deaths at the County-USC Medical Center, which operates the busiest emergency rooms in the nation, has dropped about 18% since the development of a new emergency medical program in 1991, according to a study released Friday.

Deaths caused by injuries from traffic accidents, gunshot wounds, stabbings and falls all have showed a marked decline since the program began, according to the study, written by a team of USC Medical School trauma specialists and published in the February edition of the Archives of Surgery.

The new multimillion-dollar program upgraded County-USC’s trauma center with a full-time staff of surgeons and other medical personnel and instituted improvements in the intensive care unit and in admission and follow-up procedures.

“The addition of a dedicated trauma program at our center made a significant improvement in the outcome of severely injured patients,” said Dr. Demitrios Demetriades, the lead author of the paper and head of the new program.

The study added fuel to arguments that money can make a dramatic difference in saving the lives of critically injured trauma victims.

Nationally, trauma results in more than 150,000 deaths a year and about 400,000 permanent disabilities. At County-USC, of the 737 patients studied in 1991, before the program was implemented, 221 died of their injuries. Two years later, 199 of the 812 patients studied died.

Previous studies have shown that a number of in-hospital trauma deaths were preventable, but this is believed to be the first such study focused on County-USC.

David Langness, a spokesman for the Healthcare Assn. of Southern California, which represents local hospitals, applauded the findings.

“Trauma centers are dollar-intensive,” he said. “The more money we put in trauma, the more people we will save. There is no question that with better funding we could save more lives in Los Angeles County.”

*

Since the county’s trauma network began in the early 1980s with 23 hospitals, 11 have dropped out because of financial problems. Emergency rooms have to meet demanding--and costly--criteria, such as having a surgeon on duty 24 hours a days, before they can qualify as a trauma center.

County-USC has remained in the network as its largest cog, handling 28% of all trauma cases in the county. Although it has had a reputation for a first-rate emergency room, the hospital was often criticized for being short of adequate staff to treat trauma patients.

To run the new trauma program, Demetriades was recruited from Johannesburg, South Africa, where he headed one of the world’s busiest trauma units. He was given an annual budget of $2.2 million by the County Board of Supervisors and Department of Health Services.

Demetriades said the money allowed for the recruitment of specialty trauma surgeons and provided funds for advanced training for nurses and other emergency room workers.

The trauma program operates with eight full-time surgeons from the USC faculty who do nothing but supervise trauma treatment 24 hours a day. In the past, Demetriades said, surgery residents--surgeons in training at the medical school--often worked alone, without supervision.

“We made it a rule that every single trauma case in the operating room is supervised by a member of the trauma faculty,” he said.

The surgeon also said that when he arrived in 1992, only two emergency room workers had advanced trauma life-support certificates, which require intensive training in trauma procedures. Now 100 health care workers at the hospital have the certificates.

Among the other changes, Demetriades said that as soon as members of his team receive word that a trauma case is on the way, they go to the receiving area and wait until the victim arrives “so there is no delay in the diagnosis and management of the patients.”

Demetriades said the payoff is evident from the results of the study. “They put a lot of money and effort into it, and there were positive results,” he said.

The study showed that the death rate of patients suffering from all trauma injuries dropped from 30% in 1991 to 24.5% in 1993, a reduction of 18.3%.

The reduction in the mortality rate for patients suffering serious blunt trauma injuries, usually the kind suffered in falls or traffic accidents, was even higher--33%--going from 31.1% to 20.8% in two years.

*

The overall mortality for patients suffering penetrating trauma, such as those caused by gunshot or knife wounds, did not change. But the researchers said that in patients who had the most severe gunshot or knife wounds there was a 42.7% reduction in mortality in 1993. Slightly more than 50% of all trauma injuries at the hospital are caused by either gunshot or knife wounds.

Researchers also reported a significant drop in permanent disabilities among survivors of trauma injuries.

County-USC, located in Boyle Heights near Downtown Los Angeles, treated 6,500 trauma injuries in 1993. The researchers selected only those who registered highest on an injury severity index commonly used in the medical industry.

Demetriades said that although Los Angeles County has experienced a significant decrease in serious crime over the last several years, including a sharp drop-off in murders, he did not believe the downtrend in violent crime influenced the results.

He said the number of trauma injuries at County-USC held steady between 1991 and 1993, but the number of deaths dropped off.

Demetriades was formerly chief of surgical services and led the burn unit at Baragwanath Hospital in Johannesburg. The hospital is considered to be the largest trauma center in the world, three times the size of County-USC.

He is considered an expert in the use of antibiotics in trauma recovery, burn recovery and penetrating injuries to the abdomen, chest and neck.