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Evaluation of the Patients, Injuries and Course of Traumatic Orthopedic Injuries Admitted at a Level II Trauma Center Before and After the Implementation of an Orthopedic Trama Service.

1 August 2007


The purpose of this retrospective chart review is to show any changes in the course of traumatic orthopedic injuries received at a level II trauma center before and after the implementation of an orthopedic trauma service (OTS). Background: Sacred Heart Medical Center is located in the Willamette Valley and is surrounded by smaller medically underserved communities. As the first level II trauma center on the Interstate 5 corridor heading north to Portland from the California border, Sacred Heart is ideally located as a level II center to treat orthopedic injuries sustained in this highly recreational and industrious region. This study will report on the types of patients . seen, injuries the patients sustained and the surgical course provided for these patients. A six month patient sample before, during and after the implementation of an OTS will be evaluated. Hypothesis: Patient demographics and injury profiles will diversify and surgical course will improve with shortened times between evaluation and surgery after the implementation of a dedicated OTS. Study Design: Retrospective chart review. Methods: Patients were identified as orthopedic trauma patients by the state trauma registry, medical records and the Current Procedural Terminology (CPT) codes used in the coding of the procedures done. Three six-month time periods were analyzed: April 1, 2003-September 30,2003 (pre-establishment of OTS), April 1, 2005-September 30,2005 (transitional time), and April 1, 2006-September 30, 2006 (post-establishment of OTS). Patient demographics, including age, sex, race, zip code of resident, insurance status, were identified and compared. Patient injury demographics and course of care were identified including, injury severity score (ISS) as generated by computer and by a coder (Hand ISS), time from scene or transfer to hospital, time to first orthopedic procedure; procedure(s) done, surgeon performing the surgery and length of stay. Data was gathered from the orthopedist patient records, the hospital patient records, and the state trauma registry. Patient records not found to be common in all three locations were excluded. Results: Patient demographic for patients residing with in the hospital county verses patients residing outside the ' county were compared pre and post establishment of an OTS. There was essentially no statistical difference in these patient populations. The Injury Severity Score (ISS) was mildly elevated in post OTS patients (15.57) vs pre OTS (14.73) however not significantly P=0.4239. Length of Stay (LOS) was significantly shorter in the post OTS time with 6.9 days vs pre OTS time with 10.8 days P


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