title: Comparison of the effectiveness of major trauma services provided by tertiary and secondary hospitals in malaysia.
abstract: BACKGROUND
  The effectiveness of trauma services provided by three hospitals operating at different levels of care, district general (DGH), tertiary care, and central tertiary, were compared in Malaysia.
  
  
  METHODS
  Cases were recruited prospectively for 1 month. Outcome measures included death or, among survivors, disability at discharge.
  
  
  RESULTS
  Leading causes of injuries were road traffic (72%), falls (9%), industrial (6%), and assaults (5%). Fifty-nine percent of cases were direct admissions and 41% were interhospital transfers. Of the 286 direct admissions, 12% arrived by ambulance and the remainder mostly by private car. For direct admissions, logistic regression identified an increased odds of dying associated with admission to DGH (compared with central tertiary) (odds ratio [OR], 9.8; 95% confidence interval [CI], 1.3-73.7), severe injuries (Injury Severity Score > 15) (OR, 33.1; 95% CI, 7.5-146.7), and older age (> or = 55 years) (OR, 10.8; 95% CI, 2.0-56.8). Disability at discharge was associated with being severely injured (OR, 6.4; 95% CI, 2.4-17.1).
  
  
  CONCLUSIONS
  In this study in Malaysia, admission to DGH, older age, and severe injuries are associated with increased odds of fatality.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006767:Hospitals, District / Q000592:standards; D006769:Hospitals, General / Q000145:classification / Q000592:standards; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data*; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy*