title: The Delaware trauma system: impact of Level III trauma centers.
abstract: BACKGROUND
  In 2000, Delaware instituted a trauma system that included establishing four Level III trauma centers in counties previously without trauma centers. The purpose of this study was to analyze whether implementation of this inclusive trauma system reduced the injury-related mortality rates in these counties.
  
  
  METHODS
  Using the state trauma registry, patients with trauma admitted to all acute care hospitals in Delaware from January 1, 1995 through December 31, 2004 were identified and categorized into two groups: preimplementation of an inclusive trauma system (1995-1999), and postimplementation (2000-2004). These groups were compared in aggregate and by individual counties for age, sex, mechanism of injury, Abbreviated Injury Score, injury-related mortality rate, mean Injury Severity Score (ISS), acute transfers out, and acute transfers in (Level I only). chi test and Mann-Whitney U test were used where indicated. Significance was determined to be p < or = 0.05.
  
  
  RESULTS
  After implementation, mortality rates significantly decreased (5.3%-2.8%) and rate of acute transfers out increased (14.7%-19.5%) in the counties served by the Level III centers. The ISS of patients in the Level I trauma center significantly increased (mean ISS = 10) when compared with the Level III trauma centers (mean ISS = 6), reflecting increased transfers of patients with severe injuries.
  
  
  CONCLUSIONS
  An inclusive state trauma system that included the establishment of Level III trauma centers in previously underserved counties led to a decrease in trauma-related mortality rates in these counties. In the county served by the Level I trauma center, mortality remained unchanged despite an increase in admissions and the injury severity of these admissions.
authors.affiliation: Department of Surgery, Christiana Care Health System, Newark, New Jersey, USA. gtinkoff@christianacare.org
authors.forename: Glen H
authors.initials: GH
authors.lastname: Tinkoff
authors.forename: Robert E
authors.initials: RE
authors.lastname: O'Connor
authors.forename: Edward L
authors.initials: EL
authors.lastname: Alexander
authors.forename: Mary Sue
authors.initials: MS
authors.lastname: Jones
mesh_terms: D000328:Adult; D003691:Delaware; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data; D016730:Program Development; D012042:Registries; D016019:Survival Analysis; D014193:Trauma Centers; D014194:Traumatology / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality*