The impact of a dedicated trauma program on outcome in severely injured patients.
BACKGROUND
In recent years, many trauma centers have been closing or scaling down their operations because of financial losses and lack of commitment by the relevant authorities.


OBJECTIVE
To investigate the effect of commitment to trauma and the establishment of a dedicated trauma program on injury outcome.


METHODS
In 1992, a well-funded dedicated trauma program was implemented at the Los Angeles County--University of Southern California Medical Center, Los Angeles. We analyzed the outcome in severely injured patients (Injury Severity Score [ISS] > 15) before and after implementation of the program (1991 and 1993).


METHODS
Large, urban, level 1 trauma center.


METHODS
Patients with trauma and an ISS higher than 15.


RESULTS
There were 737 patients with an ISS higher than 15 in 1991 and 812 patients with an ISS higher than 15 in 1993. The overall mortality rate was 30% in 1991 and 24.5% in 1993 (P = .018), which is a reduction by 18.3%. In patients with blunt trauma and an ISS higher than 15, mortality was reduced by 33% (mortality rate of 31.1% in 1991 vs 20.8% in 1993) (P < .002). Mortality in patients with penetrating trauma and an ISS higher than 30 was reduced by 42.7% (mortality rate of 59.3% in 1991 vs 34% in 1993) (P = .019). There was also a trend toward lower permanent disabilities among survivors with an ISS higher than 15 (14.7% in 1991 vs 11.3% in 1993).


CONCLUSIONS
Commitment of financial and human resources for the establishment of a dedicated trauma program is a sound investment in terms of improved survival and fewer permanent disabilities in critically injured patients.
Demetriades
D
D
Department of Surgery, Los Angeles County--University of Southern California Medical Center.
Berne
T V
TV
Belzberg
H
H
Asensio
J
J
Cornwell
E
E
Dougherty
W
W
Alo
K
K
DeMeester
T R
TR
D000063:Accidents, Traffic / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy