A statewide system of trauma care in Victoria: effect on patient survival.
OBJECTIVE
To determine whether the statewide system of trauma care introduced in 2000 has resulted in improved survival for all major trauma patients in Victoria.


METHODS
Population-based cohort study using data from the Victorian State Trauma Registry (VSTR), a registry of all hospitalised major trauma patients in Victoria. The study included major trauma patients with an Injury Severity Score > 15 captured by the VSTR between July 2001 and June 2006.


METHODS
In-hospital mortality.


RESULTS
The number of major trauma cases captured by the registry rose from 1153 in 2001-02 to 1737 in 2005-06. Adjusting for key predictors of mortality, there was a significant overall reduction between 2001-02 and 2005-06 in the risk of death for patients treated in the trauma system (adjusted odds ratio [AOR], 0.62 [95% CI, 0.48-0.80]). The reduced risk of death was also significant when road trauma cases (AOR, 0.56 [95% CI, 0.39-0.80]) and serious head injury cases (AOR, 0.62 [95% CI, 0.46-0.83]) were analysed separately. The proportion of road trauma patients definitively treated at one of the three major trauma service (MTS) hospitals in Victoria rose by 7% over the 5-year period. Direct transfers from the scene of injury to MTS hospitals rose by 8% for all cases and 13% for road trauma cases over the same period.


CONCLUSIONS
Introduction of a statewide trauma system was associated with a significant reduction in risk-adjusted mortality. Such inclusive systems of trauma care should be regarded as a minimum standard for health jurisdictions.
Cameron
Peter A
PA
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Peter.Cameron@med.monash.edu.au
Gabbe
Belinda J
BJ
Cooper
D James
DJ
Walker
Tony
T
Judson
Rodney
R
McNeil
John
J
D000328:Adult; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012041:Regional Medical Programs / Q000458:organization & administration*; D012042:Registries; D012189:Retrospective Studies; D014194:Traumatology / Q000458:organization & administration*; D014739:Victoria / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult