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Texas hospital trauma centers drop the ball on neck CT scans, other imaging

Delayed diagnosis and treatment of neck injuries can lead to permanent paralysis

According to a recent article in Becker’s Hospital Review, hospitals that are part of the mega-chain of hospitals called HCA Healthcare have an average trauma center activation fee of 10 times higher than non-HCA hospitals. That can be up to $50,000 per patient—that’s just the trauma activation fee and applies before any care is actually provided at the hospital.

From my perspective as a former hospital administrator, it seems that just about every hospital has become a trauma center. With these types of fees in play, I can see why. And just because a hospital has a trauma center designation, it doesn’t mean the quality of care is always spot-on.

Trauma center levels

The American Trauma Society recognizes five different levels of trauma centers, designated by the first five Roman numerals. A Level I trauma center has the most comprehensive resources.

Each state develops its own criteria for designating trauma facilities within its borders. In Texas, this is handled by the Department of State Health Services. Here’s the current breakdown of trauma-designated centers in the Lone Star State:

• Level I Comprehensive Trauma Facilities:  19 facilities

• Level II Major Trauma Facilities:  25 facilities

• Level III Major Trauma Facilities:  63 facilities

• Level IV Major Trauma Facilities:  193 facilities

The ideas behind developing trauma centers are sound. Emergency medical services (EMS) should be connected with hospitals that have appropriate staffing, equipment, supplies, and training to handle from emergencies. This should lead to better patient outcomes.

In practice and implementation, though, that’s not always achieved. I’ve handles many cases where designated trauma centers in Texas have major performance issues that led to serious patient harm. Two cases immediately come to mind, both of them involved diagnostic radiology scans of the neck.

No neck imaging in a high-speed motor vehicle collision

A man was taken by ambulance to a Plano Level I trauma center hospital after his car front-end crashed into a tree at around 60 miles per hour. There was a trauma activation and the patient was met in the emergency room (ER) by trauma team personnel.

In a blunt trauma situation such as this, the patient presents to the hospital with potential injuries in every body part. The trauma team ordered diagnostic radiology imaging for his head/brain and entire back, but incredibly skipped his cervical spine (neck). He was taken to the operating room to deal with emergency abdominal bleeding and then admitted to the intensive care unit (ICU).

During this entire time, his neck had not been imaged and no spinal precautions (c-collar) were in place. Overnight in the ICU, his neurologic status declined—he couldn’t move his legs. The next day, the symptoms worsened and they finally imaged his cervical spine, revealing distracting injuries and spinal cord compression. Before he was taken to spine surgery, he was already quadriplegic.

All this happened as a Level I trauma center.

Not paying attention neck imaging findings

In the second case, a woman was taken by ambulance to a Kingwood Level I trauma center after falling face-first onto her driveway in icy conditions. Upon presentation to the ER, she complained of head, neck, shoulder, and wrist pain, but denied any back pain.

Once again, the woman was quickly seen in the ER by trauma team members. This time, diagnostic imaging orders included a CT scan of the neck. The radiologist interpreted the CT scan as showing moderate to severe spinal stenosis.

This is a finding that can be consistent with spinal cord compression, which can cause permanent, serious, disabling injuries. Unfortunately, though, it cannot be verified by CT scan. The radiologist failed to recommend in order for an MRI scan and none of the clinical doctors one followed up.

The patient was discharged to home with a diagnosis of back sprain. The ER nurse noted that the patient was still weak and documented “MD aware,” but didn’t do anything about it.

The patient deteriorated and returned by ambulance to a different hospital a few days later. When an MRI of the neck was finally scanned, it showed spinal cord compression. Unfortunately, by then the patient had permanent injuries that were not completely relieved even after spinal decompression surgery.

My take-home message is that patients should be vigilant even in trauma centers. Ask for copies of radiology reports and then ask questions to the attending physician about missing studies or findings before being discharged. Emergency room and trauma centers can be busy places and glaring problems can sometimes fall through the cracks, in violation of the standard of care.

If you’ve been seriously injured because of poor hospital, emergency, or trauma center care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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