title: A comparison of major trauma patients transported to trauma centres vs. non-trauma centres in metropolitan Perth.
abstract: BACKGROUND
  Some major trauma patients in metropolitan Perth (area 5000 km(2)) are initially transported to a secondary hospital (non-trauma centre), rather than directly to a tertiary hospital (trauma centre). They are subsequently transferred to a tertiary hospital. We compared outcomes from these different systems of care.
  
  
  METHODS
  Major trauma (Injury Severity Score, ISS>15) data from the Trauma Registries, 1 July 1997-30 June 2006. Two groups were studied: group 1 (metropolitan major trauma transported directly to a tertiary hospital) and group 2 (metropolitan major trauma transported initially to a secondary hospital and then to a tertiary hospital). The primary endpoint was death.
  
  
  RESULTS
  Group 1 (n = 2005) and group 2 (n = 1078) mean age (43.9 ± 24.3 yrs vs. 39.1 ± 24.3 yrs, p < 0.0001) both with a median ISS = 24 (p = 0.084). Group 2 had significantly more head/neck injuries (p < 0.0001) and significantly less thoracic, abdominal and pelvis/extremities injuries (p < 0.0001). There were also a significantly greater total number of regions injured in group 1 vs. group 2 (p < 0.0001). Mean times to definitive care were 59 min vs. 4.5h, respectively (p < 0.0001). After adjusting for age, ISS, RTS, total regions injured and time, the OR for death in group 2 was 0.99 (95% CI 0.58-1.68).
  
  
  CONCLUSIONS
  There is an equivalent risk of major trauma death in these two systems of care. In our metropolitan area, we were unable to demonstrate a mortality benefit associated with time.
authors.affiliation: Emergency Medicine, Royal Perth Hospital, University of Western Australia, Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Australia. daniel.fatovich@health.wa.gov.au
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fatovich
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Ian G
authors.initials: IG
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009017:Morbidity; D015996:Survival Rate; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014904:Western Australia / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*