title: Impact of a voluntary trauma system on mortality, length of stay, and cost at a level I trauma center.
abstract: Trauma systems have been shown to decrease injury-related mortality; however, their development has been slow often requiring legislative codification. The purpose of this study was to evaluate the impact of a voluntary regional trauma system on outcomes at a Level I trauma center. We conducted a retrospective cohort study in an American College of Surgeons-verified Level I trauma center including all patients admitted to a Level I trauma center during the periods April 1995 through March 1996 (T-1) and April 1997 through March 1998 (T-2). Our main outcome measures were in-hospital mortality, hospital length of stay, cost of care Compared with T-1 patients T-2 patients had lower mortality (odds ratio 0.48, 95% confidence interval 0.32-0.71). A similar decline in mortality was observed for the entire six-county region compared with the remainder of the state. Among the most severely injured patients (Injury Severity Score > or = 16) T-2 patients had a shorter length of stay (16.5 vs 19.5 days; P < 0.05) and lower mean cost of care ($29,795 vs $34,983; P < 0.05). A voluntary trauma system can be implemented without the need for legislative mandate. After system implementation patient and financial outcomes were improved at an individual Level I trauma center.
authors.affiliation: Department of Surgery, School of Medicine, University of Alabama at Birmingham, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Abernathy
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: Joe E
authors.initials: JE
authors.lastname: Acker
authors.forename: Loring W
authors.initials: LW
authors.lastname: Rue
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D012041:Regional Medical Programs / Q000458:organization & administration*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D014218:Triage; D014947:Wounds and Injuries / Q000145:classification / Q000191:economics / Q000401:mortality