Receiving timely and specialized care is critical for patients with brain injuries, since secondary damage can occur during the hours following an injury. However, patients injured in rural areas often must travel farther and longer to reach specialized care facilities.

With the goals of reducing injury deaths, improving patient outcomes and reducing medical care costs, the Iowa trauma system was established in 1995 through state legislation titled the Iowa Trauma System Care Development Act. The system was fully implemented statewide in January 2001. Features of the system include categorization and verification of each hospital, training in advanced trauma life support, definition of triage protocol, and uniform data definition and collection. Two Level I and seven Level II hospitals in the statewide system were required to have specialty coverage, including neurosurgery for traumatic injuries.

University of Iowa Hospitals and Clinics has been certified as a Level I Trauma Center for adult and pediatric patients--the highest level of trauma center designation the American College of Surgeons offers.

The Level I Trauma Center has also been verified as a Resource Trauma Care Facility by the Iowa Department of Public Health. This represents the highest level of designation within the statewide trauma care delivery system.

Level I designation means UI Hospitals and Clinics has trained and capable personnel available 24 hours a day, seven days a week for diagnosing and treating the most critically injured patients. It also means the trauma center has the facilities and equipment necessary to provide specialized care, and that staff members are actively involved in ongoing self-assessment of care and the care delivery system.

To examine how Iowa's trauma system affected the triage and in-hospital death rates of brain-injured patients, the investigators analyzed data from the State Trauma Registry maintained by the Bureau of Emergency Medical Services in the Iowa Department of Public Health (IDPH). The researchers assessed TBI patient survival two years before the implementation of the trauma system (1997-1998) compared to two years after full implementation (2002-2003). The data included 710 pre-system patients and 886 post-system patients with moderate or severe head injury.

The study found that implementation of the trauma system was associated with a significant decreased risk of death overall—and a nearly 50 percent decreased risk of death in the 72 hours following a TBI—for both patients directly admitted to Level I and II hospitals and those transferred from local hospitals. The study appeared in the July 7 issue of the Journal of Neurotrauma.

"Implementation of the Iowa trauma system has led to more appropriate triage and transport for TBI patients, and this likely contributed to reduced in-hospital mortality," said study co-author James Torner, PhD, UI professor of epidemiology. "The implication is that a system featuring categorization of hospitals based upon capabilities, educational standards for hospital staff, and triage protocols for transferring severely injured patients to comprehensive care trauma facilities saves lives."

"Iowans should be proud of the collaborative effort among IDPH, Iowa hospitals and EMS providers to develop this system that has now been proven to save lives," said Mary Jones, IDPH deputy director and head of the IDPH Division of Acute Disease Prevention and Emergency Response. "Special thanks should also go to all the physicians, nurses and paramedics dedicated to injury prevention and care in Iowa," she added.

In addition to Torner, the researchers included lead author Hope Tiesman, PhD, Tracy Young and Corinne Peek-Asa, PhD, all with the UI Injury Prevention Research Center; Mark McMahon at IDPH; and John Fiedler, IDPH state trauma system coordinator.

For more information:

Level I Trauma Center

James Torner, PhD

Journal of Neurotrauma