Improved trauma patient outcomes after implementation of a dedicated trauma admitting service.
BACKGROUND
Regionalised trauma systems have been shown to improve the outcome of seriously injured patients. However, it is not clear which components of these systems have the most impact on patient outcomes. The study evaluates the association between implementation of a single, dedicated trauma admitting service at an urban trauma centre and subsequent patient outcomes.


METHODS
This was a retrospective review of prospectively collected trauma registry data at the St George Public Hospital, a level I urban trauma centre in Sydney, Australia. Two concurrent 18-month periods, before and after implementation of a full-time trauma service, were compared for differences in patient mortality, complication rates, and ED, ICU and hospital lengths of stay.


RESULTS
There were 962 patients admitted to the hospital in the 18 months immediately preceding the implementation of the trauma service (the PRE group) and 990 patients in the subsequent 18 months (the POST group). There were no significant differences between groups with respect to patient demographics or mechanism of injury, although a higher proportion of patients in the POST group had injury severity scores (ISS) above 15 (30.6% versus 24.8%, p=0.02). There was an 8% reduction in death rate among the most severely injured patients (ISS>15), in the POST group as compared to the PRE group (12.2% and 20.2% respectively, p=0.007).


CONCLUSIONS
The implementation of a full-time trauma service in this hospital was associated with a reduction in death rate among the most severely injured patients, and a decrease in LOS in patients with an ISS<15.
Ursic
Caesar
C
Trauma Service St George Hospital, Gray Street, Kogarah, NSW 2217, Australia.
Curtis
Kate
K
Zou
Yi
Y
Black
Deborah
D
D000328:Adult; D000368:Aged; D001315:Australia; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014194:Traumatology / Q000379:methods; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult