title: Mortality decreases by implementing a level I trauma center in a Dutch hospital.
abstract: BACKGROUND
  Trauma centers are designed to improve survival and outcome of the injured patient. The implementation of these centers in the United States has shown to reduce the number of preventable deaths from serious injuries. This study compares outcomes of trauma patients during two separate time periods in a Dutch Level I trauma center, before and after obtaining the trauma center status.
  
  
  METHODS
  Prospectively, patient data were collected from an automated database in the years 1996 through 1998 (period 1) and 2003 through 2005 (period 2) in the University Medical Center in Utrecht. The patients included and analyzed were adult trauma victims admitted to our trauma center.
  
  
  RESULTS
  A total of 4,069 patients in total were included, 2,348 in period 1 and 1,721 in period 2. Mean age was 45.9 years and 48.1 years, respectively (p < 0.001). Men comprised 62% and 64%, respectively (not significant). After obtaining the trauma center status, more severely injured patients were admitted (mean Injury Severity Score was 9.6 in group 1 vs. 12.4 in group 2, p < 0.001). Adjusted for age and injury severity, the inhospital mortality was lower (odds ratio: 0.606, p < 0.05) in the second group. Adjusted for age, Injury Severity Score, and mortality, the hospital stay was shorter (p < 0.001) in the second group. Fewer patients were admitted to the intensive care unit (p < 0.001), but the length of stay appeared longer (p = 0.055) after trauma center designation.
  
  
  CONCLUSIONS
  This study implies that the implementation of a trauma center reduces mortality, shortens hospital stay, and decreases the number of intensive care unit admittances in Utrecht, the Netherlands.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Anique T E
authors.initials: AT
authors.lastname: Spijkers
authors.forename: Sven A G
authors.initials: SA
authors.lastname: Meylaerts
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality*