title: Assessing effectiveness of a mature trauma system: Association of trauma center presence with lower injury mortality rate.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, University of Florida, Gainesville, Florida 32608, USA. lpstat@aol.com
authors.forename: Linda
authors.initials: L
authors.lastname: Papa
authors.forename: Barbara
authors.initials: B
authors.lastname: Langland-Orban
authors.forename: Celleste
authors.initials: C
authors.lastname: Kallenborn
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Tepas
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lottenberg
authors.forename: Brian
authors.initials: B
authors.lastname: Celso
authors.forename: Rodney
authors.initials: R
authors.lastname: Durham
authors.forename: Lewis
authors.initials: L
authors.lastname: Flint
mesh_terms: 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*