title: Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation.
abstract: BACKGROUND
  Regional trauma systems were proposed 2 decades ago to reduce injury mortality rates. Because of the difficulties in evaluating their effectiveness and the methodologic limitations of previously published studies, the relative benefits of establishing an organized system of trauma care remains controversial.
  
  
  METHODS
  Data on trauma systems were obtained from a survey of state emergency medical service directors, review of state statutes and a previously published trauma system inventory. Injury mortality rates were obtained from national vital statistics data, whereas motor vehicle crash (MVC) mortality rates were obtained from the Fatality Analysis Reporting System. Mortality rates were compared between states with and without trauma systems.
  
  
  RESULTS
  As of 1995, 22 states had regional trauma systems. States with trauma systems had a 9% lower crude injury mortality rate than those without. When MVC-related mortality was evaluated separately, there was a 17% reduction in deaths. After controlling for age, state speed laws, restraint laws, and population distribution, there remained a 9% reduction in MVC-related mortality rate in states with a trauma system.
  
  
  CONCLUSIONS
  These data demonstrate that a state trauma system is associated with a reduction in the risk of death caused by injury. The effect is most evident on analysis of MVC deaths.
authors.affiliation: Department of Surgery, Harborview Medical Center, University of Washington, Seattle 98104, USA. anathens@u.washington.ed
authors.forename: A B
authors.initials: AB
authors.lastname: Nathens
authors.forename: G J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: F P
authors.initials: FP
authors.lastname: Rivara
authors.forename: R V
authors.initials: RV
authors.lastname: Maier
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D011159:Population Surveillance; D015397:Program Evaluation; D012041:Regional Medical Programs / Q000592:standards*; D012042:Registries; D013221:State Health Plans / Q000592:standards*; D014193:Trauma Centers / Q000592:standards*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality* / Q000517:prevention & control*