title: Influence of a statewide trauma system on location of hospitalization and outcome of injured patients.
abstract: OBJECTIVE
  Evaluate the influence of implementing the Oregon statewide trauma system on admission distribution and risk of death.
  
  
  METHODS
  Retrospective pre- and posttrauma system analyses of hospital discharge data regarding injured patients with one or more of the following injuries: head, chest, spleen/liver, pelvic fracture, and femur/tibia fracture.
  
  
  METHODS
  Risk-adjusted odds ratio of admission to Level I or II (tertiary care) trauma centers, and odds ratio of death were determined using hospital discharge abstract data on 27,633 patients. Patients treated in 1985-1987, before trauma system establishment, were compared to patients treated in 1991-1993 after the trauma system was functioning.
  
  
  RESULTS
  After trauma system implementation, the odds ratio of admission to Level I or II trauma centers increased (odds ratio 2.36, 95% confidence interval 2.24-2.49). In addition, the odds ratio of death for injured patients declined after trauma system establishment (odds ratio 0.82, confidence interval 0.73-0.92).
  
  
  CONCLUSIONS
  The Oregon trauma system was successfully implemented with more patients with index injuries admitted to hospitals judged most capable of managing trauma patients. The Oregon trauma system also appears beneficial since trauma system establishment is associated with a statewide reduction in risk of death.
authors.affiliation: Department of Surgery, Oregon Health Sciences University, Portland, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Mullins
authors.forename: J
authors.initials: J
authors.lastname: Veum-Stone
authors.forename: J R
authors.initials: JR
authors.lastname: Hedges
authors.forename: M J
authors.initials: MJ
authors.lastname: Zimmer-Gembeck
authors.forename: N C
authors.initials: NC
authors.lastname: Mann
authors.forename: P A
authors.initials: PA
authors.lastname: Southard
authors.forename: M
authors.initials: M
authors.lastname: Helfand
authors.forename: J A
authors.initials: JA
authors.lastname: Gaines
authors.forename: D D
authors.initials: DD
authors.lastname: Trunkey
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009922:Oregon / Q000453:epidemiology; D012041:Regional Medical Programs; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality*