Influence of a new province-wide trauma system on motor vehicle trauma care and mortality.
BACKGROUND
Mature trauma systems have evolved to respond to high rates of major injury morbidity and mortality. Characterized by prehospital care, triage, transportation, aggressive resuscitation, surgery, and rehabilitation, trauma systems have been found to improve survival for seriously injured patients. In Nova Scotia, a province-wide trauma system was implemented between 1995 and 1998. This study investigated the influence of the province-wide trauma system on motor vehicle trauma care and mortality in its first 2 years of existence.


METHODS
Subjects over the age of 15 years were identified using E-codes pertaining to motor vehicle traffic crashes from population-based hospital claims and vital statistics data. Individuals who were hospitalized or died because of a motor vehicle crash in 1993 through 1994, before trauma system implementation, were compared with those who were hospitalized or died in 1999 through 2000, after the trauma system was implemented.


RESULTS
In the 2-year period after trauma system implementation, there was a 21% increase in the number of seriously injured individuals with a primary admission to tertiary care. This increase was both clinically and statistically significant even after adjustment for age, gender, multiple injuries, head injury, municipality of residence, and vital status at discharge (RR, 1.21, 95% CI, 1.05-1.35). There was no evidence that the probability of dying while in hospital significantly changed in the first 2 years after trauma system implementation.


CONCLUSIONS
These results indicate that individuals seriously injured in motor vehicle crashes in Nova Scotia are more likely to be admitted to tertiary care in the postimplementation period.
Department of Emergency, Dalhousie University, Halifax, Nova Scotia. jtallon@dal.ca
John M
JM
Tallon
Deshayne B
DB
Fell
Stacy
S
Ackroyd-Stolarz
David
D
Petrie
D000063:Accidents, Traffic / Q000401:mortality*; D000328:Adult; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D009674:Nova Scotia; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*