title: An analysis of the association of trauma centers with per capita hospitalizations and death rates from injury.
abstract: OBJECTIVE
  This study used population-based data bases to assess the association of trauma centers with per capita county hospitalization and trauma death rates in the State of North Carolina.
  
  
  BACKGROUND
  The current study extended previous work using two North Carolina data bases to assess the association of the presence of a trauma center with per capita county trauma death rates.
  
  
  METHODS
  Data on per capita county trauma hospitalizations and deaths were obtained from the state hospital discharge data base and the North Carolina Medical Examiner's data base. Bivariate and multivariate analysis techniques were used. The dependent variables of interest were prehospital, hospital, and total trauma death rates and hospitalization rates for injury.
  
  
  RESULTS
  Bivariate analysis identified a number of factors associated with per capita county hospitalizations and trauma death rates. These included the per cent unemployment, racial distribution, county alcohol tax receipts, and advanced life support certified emergency medical services providers. The per capita trauma death rates were significantly lower in counties with trauma centers compared with those without trauma centers (4.0 +/- 0.5 and 5.0 +/- 1.1 deaths per 10,000 population, p = 0.0001, respectively). The per capita hospitalizations for trauma were also lower in counties with trauma centers. Multivariate modeling showed that the presence of a trauma center and advanced life support providers were the best predictors of decreased per capita county trauma death rates.
  
  
  CONCLUSIONS
  The study showed that the presence of a trauma center and advanced life support training were the two medical system factors that were the best predictors of the per capita county prehospital and total trauma death rates. These findings are consistent with the hypothesis that trauma centers are associated with a decrease in trauma death rates.
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill School of Medicine.
authors.forename: R
authors.initials: R
authors.lastname: Rutledge
authors.forename: S M
authors.initials: SM
authors.lastname: Fakhry
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.forename: G F
authors.initials: GF
authors.lastname: Sheldon
authors.forename: C C
authors.initials: CC
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D012044:Regression Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data* / Q000600:supply & distribution; D014947:Wounds and Injuries / Q000401:mortality*