Standardized mortality ratio analysis on a sample of severely injured patients from a large Canadian city without regionalized trauma care.
Flora's Z statistic and standardized mortality ratios (SMRs) as indicators of excess mortality were calculated for a sample of 355 patients with major trauma. A statistically significant overall excess mortality was observed in this sample (Z = 6.77, SMR = 1.81, p less than 0.05). Advanced life support provided by physicians at the scene (MD-ALS) was not associated with reduced excess mortality. A significant trend toward lower excess mortality was associated with a higher level of trauma care at the receiving hospital (p less than 0.05). Total prehospital time over 60 minutes was associated with a significant increase in excess mortality (p less than 0.001). These results support regionalization of trauma care and failed to show any benefit associated with MD-ALS.
Sampalis
J S
JS
Department of Surgery, McGill University, Montreal, Quebec, Canada.
Lavoie
A
A
Williams
J I
JI
Mulder
D S
DS
Kalina
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D012041:Regional Medical Programs; D013223:Statistics as Topic; D013997:Time Factors; D014505:Urban Population; D014947:Wounds and Injuries / Q000401:mortality*