Assessing effectiveness of a mature trauma system: Association of trauma center presence with lower injury mortality rate.
OBJECTIVE
To determine effectiveness of trauma center care in a mature trauma system by comparing motor vehicle crash (MVC) death rates in counties with a trauma center (TC) to those without a trauma center (NTC).


METHODS
State data for MVCs occurring in 2003 were analyzed. Fatalities from crashes in counties with a TC were compared with NTC counties. The primary outcome was case-fatality rate and the secondary outcome was crash-fatality rate. Data from 67 Florida counties and 20 TCs were assessed. Covariates such as age, speed, alcohol use, prehospital resources, and rural/urban location were adjusted for in the analysis.


RESULTS
The statewide incidence of fatality from MVC in 2003 was 18.6 per 100,000. The overall state case-fatality rate was 2.8% (95% CI = 2.4-3.3). There were 13 TC counties with a mean fatality rate of 17.7 per 100,000 (95% CI = 14.5-20.9) and 54 NTC counties with a mean fatality rate 33.4 per 100,000 (95% CI = 28.8-38.0; p < 0.001). The case-fatality rate was 1.4% (95% CI = 1.1-1.7) in TC counties and 3.2% (95% CI = 2.7-3.7) in NTC counties (p < 0.001). Moreover, crash-fatality rate in TC counties and NTC counties was 1.4% (95% CI = 1.0-1.8) versus 3.3% (95% CI = 2.8-3.7) respectively (p < 0.001).


CONCLUSIONS
TC counties had significantly lower MVC death rates than NTC counties. This association was independent of age, alcohol use, speed, rural/urban location, and prehospital resources.
Papa
Linda
L
Department of Emergency Medicine, University of Florida, Gainesville, Florida 32608, USA. lpstat@aol.com
Langland-Orban
Barbara
B
Kallenborn
Celleste
C
Tepas
Joseph J
JJ
Lottenberg
Lawrence
L
Celso
Brian
B
Durham
Rodney
R
Flint
Lewis
L
D000063:Accidents, Traffic / Q000401:mortality*; D000328:Adult; D003430:Cross-Sectional Studies; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods; D014193:Trauma Centers / Q000600:supply & distribution*; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality*