title: The association between trauma system and trauma center components and outcome in a mature regionalized trauma system.
abstract: BACKGROUND
  Regionalized trauma systems have been shown repeatedly to improve the outcome of seriously injured patients. However, we do not have data regarding which components of these systems have the most impact on outcome and to what degree. The objective of this study was to understand the association between various components that make up a trauma system and outcome.
  
  
  METHODS
  Surveys were administered to trauma directors at 59 hospitals in the province of Quebec, Canada. Data from the surveys were then linked with specific outcome variables obtained from a regionalized trauma database. Specific outcomes were assigned to trauma system- and in-hospital-based components after controlling for injury severity.
  
  
  RESULTS
  Over 4.8 years, 72,073 patients met inclusion criteria. Components found to affect survival after risk adjustment were prehospital notification (OR, 0.61; 95% CI, 0.39-0.94) and the presence of a performance improvement program in that hospital (OR, 0.44; 95% CI, 0.20-0.94). Increased patient volume was associated with a reduction in risk-adjusted mortality (OR, 0.98; 95% CI, 0.97-0.99). Tertiary trauma centers were also associated with a reduction in risk-adjusted mortality compared with both secondary and primary centers (OR, 0.68; 95% CI, 0.48-0.99).
  
  
  CONCLUSIONS
  Improvements in outcome in a regionalized trauma system are secondary to a combination of elements, as well as to the interplay of these elements on each other. Prehospital notification protocols and performance improvement programs appear to be most associated with decreased risk-adjusted odds of death.
authors.affiliation: Department of Surgery, Montreal General Hospital, McGill University Health Center, Quebec, Canada.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: John S
authors.initials: JS
authors.lastname: Sampalis
mesh_terms: D004631:Emergency Medical Service Communication Systems; D006801:Humans; D015601:Injury Severity Score; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care; D011792:Quebec; D020379:Risk Adjustment; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*