title: The effect of an organized trauma system on mortality in major trauma involving serious head injury: a comparison of the United kingdom and victoria, australia.
abstract: OBJECTIVE
  To compare outcomes following major trauma involving serious head injury managed in an inclusive trauma system (Victoria, Australia) and a setting where rationalization of trauma services is absent (England/Wales).
  
  
  BACKGROUND
  The introduction of regionalized trauma systems has the potential to reduce preventable deaths, but their uptake has been slow around the world. Improved understanding of the benefits and limitations of different systems of trauma care requires comparison across systems.
  
  
  METHODS
  Mortality outcomes following major trauma involving serious head injury managed in the 2 settings were compared using multivariate logistic regression. Data pertaining to the period July 2001 to June 2006 (inclusive) were extracted from the Trauma Audit and Research Network (TARN) in the United Kingdom and the Victorian State Trauma Registry (VSTR) in Australia.
  
  
  RESULTS
  A total of 4064 (VSTR) and 6024 (TARN) cases were provided for analysis. The odds of death for TARN cases were significantly higher than those for VSTR cases [odds ratio = 2.15, 95% confidence interval = 1.95-2.37]. After adjusting for age, gender, cause of injury, head injury severity, Glasgow Coma Scale score, and Injury Severity Score, TARN cases remained at elevated odds of death (3.22; 95% confidence interval = 2.84-3.65) compared with VSTR cases.
  
  
  CONCLUSIONS
  Management of the severely injured patient with an associated head injury in England and Wales, where an organized trauma system is absent, was associated with increased risk-adjusted mortality compared with management of these patients in the inclusive trauma system of Victoria, Australia. This study provides further evidence to support efforts to implement such systems.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia. belinda.gabbe@med.monash.edu.au
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.forename: Grad Dip
authors.initials: GD
authors.lastname: Biostat
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.forename: Maralyn
authors.initials: M
authors.lastname: Woodford
authors.forename: Tom
authors.initials: T
authors.lastname: Jenks
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D014739:Victoria