Estimated printed pages: 4
Original Source:
THE BALTIMORE SUN
Sun, The (Baltimore, MD)
Edition: FINAL
Section: NEWS
Page: 1A
October 1, 1992
Topics: injuries
hospitals
health
Maryland
Shock Trauma ranks low in survival rates report
Analysis deflates stellar reputation
Author:
Jonathan Bor;
Staff Writer
Long touted as an international model, the Maryland Shock
Trauma Center has received low scores in an independent analysis
that compared its survival rates with those of about 70 trauma
centers across the United States.
Two spokesmen for Shock Trauma yesterday defended its
reputation, saying the study used flawed methods that failed to
account for the relatively severe injuries of patients treated
there.
"It's not apples to apples and oranges to oranges," said Dr.
David Gens, a Shock Trauma surgeon who runs the center's internal
data bank.
But in a sharply worded letter, the state's trauma chief,
Kimball I. Maull, said the study challenges the myth of Shock
Trauma's preeminence. The letter, obtained by The Sun, was sent
Sept. 9 to Dr. Errol L. Reese, the president of the University of
Maryland at Baltimore, which is affiliated with Shock Trauma.
"Graphs showing declining mortality have been released to the
public, seeming to prove remarkable survival for patients brought
to the Shock Trauma Center. In my opinion, the public, our
legislators and our own staff have been intentionally misled,"
wrote Dr. Maull, director of the Maryland Institute for Emergency
Medical Services Systems, which oversees Shock Trauma.
Dr. Maull, who was out of town yesterday, could not be reached
for comment.
Dr. Morton I. Rapoport, chief executive officer of the
university medical system, announced in a prepared statement
yesterday the formation of two panels to study the care given at
Shock Trauma and to recommend improvements.
The study is the latest development in the turmoil that has
surrounded the center since Dr. Maull assumed its leadership in
February and began a series of sweeping changes. These included the
firing of three doctors, the demotion of another and moves to put
the center in closer partnership with the University of Maryland
Medical Center.
His decision to submit to an analysis of Shock Trauma's
performance marked the first time its reputation was put to a
national test.
"In interpreting the data, be mindful that this is a
comparison with the nation's leading trauma centers, not with all
hospitals that take care of the injured," Dr. Maull wrote in the
letter. "By the same token, as I wrestle with the question, `Are we
who we say we are?', the answer is clearly that we are not."
In the 1980s, the American College of Surgeons commissioned
Tri-Analytics, a private company based in Bel Air, to build a data
bank. The work was paid for by a grant from the federal Centers for
Disease Control. Between 1982 and 1989, the company accumulated
information about 174,000 injured patients across the country. The
data was used to establish a picture of how trauma centers compared
to each other based on the survival rates they achieved.
Shock Trauma did not participate at the time. But this year,
Dr. Maull submitted data from 1989 and 1990, and asked for an
analysis of how Shock Trauma measured up to other institutions in
retrospect.
On two measures -- treatment of blunt injuries from crashes
and falls and treatment of penetrating injuries such as gunshot
wounds and stabbings -- Shock Trauma ranked near the bottom.
* In blunt trauma, Shock Trauma ranked fifth from the bottom
of the chart, grouped with eight others that fell below a vast
middle ground of about 54 centers whose survival rates constituted
a national norm. Seven centers were above average.
* In penetrating trauma, Shock Trauma got the worst score,
grouped with eight centers that fell below the norm. About 58 were
within the norm, and two were better than average.
On the charts, the names of the other hospitals were not
revealed.
Shock Trauma has not released the study. In an interview
yesterday, two officials said Dr. Maull had the only copy.
The officials -- Dr. Gens and John Ashworth, vice president of
the University of Maryland Medical System -- confirmed that Shock
Trauma fell below national norms. But they insisted that the study
is a tool for tracking a hospital's progress from year to year, not
a yardstick for comparison with others.
The Major Trauma Outcome Study uses a complex formula to
compare the survival rates of institutions.
It factors in the severity of the patients' worst injuries,
the patients' ages, and their blood pressure, breathing and brain
function.
In this way, the study tried to avoid penalizing centers that
treat large numbers of patients whose chances for survival were
relatively poor.
But Mr. Ashworth said the study failed to account for Shock
Trauma's status as a statewide center for brain-injured patients.
Patients are more likely to die from a brain injury than any other
type of wound, he said.
Also, Dr. Gens said, most institutions collected their data
using common methodology. Because Shock Trauma didn't participate
until this year, it was forced to adapt statistics kept in a
completely different manner, possibly skewing the results.
"I'm not even looking at the numbers because they're not
representative of anything," Dr. Gens said.
Dr. Wayne Copes, vice president of Tri-Analytics, said he
couldn't comment on the Shock Trauma results until he spoke with
Dr. Maull.
"I can tell you this," he said. "We have done a lot of
published research. It's widely used and quoted in many ongoing
research studies, and it's had a lot of scrutiny."
Former state Sen. Francis X. Kelly, a board member of the
University of Maryland Medical System, said he couldn't comment on
the study until he saw a copy.
"But if there are problems down there, {Dr. Maull} is there to
uncover them, to straighten them out," he said.
Copyright (c) 1992 The Baltimore Sun Company
Record Number: 0D907E6F84816880