Shock Trauma ranks low in survival rates report Analysis deflates stellar reputation

October 01, 1992|By Jonathan Bor | 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 hTC 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.

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