Trauma center designation: initial impact on trauma-related mortality.
The movement towards trauma care regionalization in Québec was initiated in 1990, with formal designation of three level I trauma centers in 1993. The purpose of this study is to evaluate the impact of trauma center designation on mortality. The study design is that of a two-cohort study, one assembled during 1987 when designation was not in effect, and the other during the first 5 months of designation. The study focuses on patients that fulfilled the following criteria: i) arrived alive at the hospital, and ii) were admitted. The outcome measures are adjusted mortality, and excess mortality as measured by the TRISS methodology. A total of 158 patients treated in 1987, and 288 treated in 1993, were identified. The mean age of the patients treated in 1993 was significantly higher (40.0, +/- 18.1), when compared with the 1987 group (30.9 +/- 18.1; p < 0.001). Patients in the 1987 cohort had a significantly higher proportion of injuries caused by stabbing (p = 0.02), and a significantly lower proportion caused by falls (p = 0.003). The 1987 cohort had a higher rate of abdominal injuries (p = 0.0001), and external injuries (p = 0.0001), and a significantly lower rate of head or neck injuries (p = 0.003), and injuries to the extremities (p = 0.0001). The mean Injury Severity Score (ISS) for the 1987 cohort was 14.96 (+/- 12.36), and 15.49 (+/- 11.61) in 1993 (p = 0.65). The crude mortality rate was 20% for 1987, and 10% for 1993. The crude odds ratio for mortality in 1987 was 2.10 with 95% confidence intervals between 1.22 and 3.62 (p = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)
Sampalis
J S
JS
Department of Surgery, Montreal General Hospital, Urgences-Santé, Canada.
Lavoie
A
A
Boukas
S
S
Tamim
H
H
Nikolis
A
A
Fréchette
P
P
Brown
R
R
Fleiszer
D
D
Denis
R
R
Bergeron
E
E
D000328:Adult; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D017063:Outcome Assessment, Health Care; D011792:Quebec; D012042:Registries; D014193:Trauma Centers / Q000145:classification*; D014947:Wounds and Injuries / Q000401:mortality*