Influence of a statewide trauma system on pediatric hospitalization and outcome.
BACKGROUND
During the years 1987-1991, a statewide trauma system was implemented in Oregon (Ore) but not in Washington (Wash). Incidence of hospitalization, frequency of death and risk-adjusted odds of death for injured children (< 19 years) in the two adjacent states were compared for two time periods (1985-1987 and 1991-1993).


METHODS
State populations of injured children (International Classification of Diseases, 9th Revision-Clinical Modification, code 800-959) were identified through a Hospital Discharge Index. Hospitals in counties with a population density < 50 persons/square mile were designated rural. Incidence rates are events/10,000 pediatric population per year.


RESULTS
The pediatric population increased in both states (Ore: 687,000-758,000; Wash: 1,159,000-1,336,000). Incidence of hospitalization for all injured children in entire states declined (Ore: 66.5-38.5; Wash: 54-33); also in rural hospitals (Ore: 67.5-32; Wash: 48 to 31). Seriously injured children (score on the Injury Severity Scale > 15) had a lower incidence in 1991-1993 of admission to rural hospitals (Ore: 2.98; Wash: 2.82) compared with incidence for entire states (Ore: 4.61; Wash: 4.62); in 1985-1987 the incidence was not different. Furthermore risk adjusted odds of death for seriously injured children was significantly lower in Oregon than in Washington in the later time period.


CONCLUSIONS
Both states show a similar temporal trend toward a declining frequency of death for children hospitalized with injuries. Injury prevention strategies appear to have reduced the number of serious injuries in both states. However, seriously injured children demonstrated a reduced risk of death in Oregon, consistent with benefit from a statewide trauma system.
Hulka
F
F
Department of Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
Mullins
R J
RJ
Mann
N C
NC
Hedges
J R
JR
Rowland
D
D
Worrall
W H
WH
Sandoval
R D
RD
Zechnich
A
A
Trunkey
D D
DD
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009922:Oregon / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*