title: The 15-year evolution of an urban trauma center: what does the future hold for the trauma surgeon?
abstract: BACKGROUND
  Safer cars, decreased violence, and nonoperative management have changed the trauma patient's nature. We evaluated changes in a Level I trauma center over 15 years and considered their effect on trauma surgeons.
  
  
  METHODS
  From January 1985 through August 1999, 16,799 trauma registry patients were analyzed for mechanism of injury, Injury Severity Score, and procedures.
  
  
  RESULTS
  Mean Injury Severity Score decreased from 15.9 to 10.7 and length of stay fell from 8.0 days to 5.9 days. There were significant decreases in penetrating trauma admissions and percentage of patients with Abbreviated Injury Scale score > 3 for head, chest, and abdomen. Frequency of craniotomy, thoracotomy, and laparotomy dropped dramatically.
  
  
  CONCLUSIONS
  Significant decreases in injury severity, penetrating violence, and operations have occurred over 15 years. These changes will have profound effects on the practice of trauma surgeons and on surgical education.
authors.affiliation: Southern California Kaiser Permanente Medical Group, San Diego Medical Center, California, USA.
authors.forename: S
authors.initials: S
authors.lastname: Engelhardt
authors.forename: D
authors.initials: D
authors.lastname: Hoyt
authors.forename: R
authors.initials: R
authors.lastname: Coimbra
authors.forename: D
authors.initials: D
authors.lastname: Fortlage
authors.forename: T
authors.initials: T
authors.lastname: Holbrook
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D002140:California / Q000453:epidemiology; D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000639:trends*; D015599:Trauma Severity Indices; D014754:Violence / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*