title: Long-lasting performance improvement after formalization of a dedicated trauma service.
abstract: BACKGROUND
  Few studies have evaluated intrainstitutional improvement of trauma care. We hypothesized that the formalization of a dedicated multidisciplinary trauma service in a major Scandinavian trauma center in 2005 would result in improved outcome.
  
  
  METHODS
  Institutional trauma registry data for 7,243 consecutive patients from the years 2002-2008 were retrospectively evaluated using variable life-adjusted display (VLAD) as one of several performance indicators. VLAD is a refinement of the cumulative sum method that adjusts death and survival by each patient's risk status (probability of survival) and provides a graphical display of performance over time. Probability of survival was calculated according to Trauma and Injury Severity Score (TRISS) methodology with National Trauma Data Bank 2005 coefficients.
  
  
  RESULTS
  VLAD demonstrated a sharp increase in cumulative survival starting at the beginning of 2005 and continuing linearly throughout the study period, amounting to 68 additional saved lives. The increase was mainly caused by improved survival among the critically injured (injury severity score 25-75). A cutoff point t0 for analysis of differences between time periods was set at January 1, 2005, coinciding with the formalization of a dedicated trauma service. Mortality in the whole trauma population showed a 33% decrease after t0. W-statistics confirmed the increased survival to be significant. There were no significant changes in age, gender, or injury mechanism. Injury severity score decreased, but differences in case mix were adjusted for in the survival prediction model.
  
  
  CONCLUSIONS
  We have shown that the start of the long-lasting performance improvement coincided with formalization of a dedicated trauma service, providing increased multidisciplinary focus on all aspects of trauma care.
authors: Department of Traumatology, Oslo University Hospital, Ulleval, Norway.
authors: Sigrid
authors: S
authors: Groven
authors: Torsten
authors: T
authors: Eken
authors: Nils Oddvar
authors: NO
authors: Skaga
authors: Olav
authors: O
authors: Roise
authors: Paal Aksel
authors: PA
authors: Naess
authors: Christine
authors: C
authors: Gaarder