title: Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system.
abstract: OBJECTIVE
  To describe outcomes of major trauma survivors managed in an organized trauma system, including the association between levels of care and outcomes over time.
  
  
  BACKGROUND
  Trauma care systems aim to reduce deaths and disability. Studies have found that regionalization of trauma care reduces mortality but the impact on quality of survival is unknown. Evaluation of a trauma system should include mortality and morbidity.
  
  
  METHODS
  Predictors of 12-month functional (Glasgow Outcome Scale-Extended) outcomes after blunt major trauma (Injury Severity Score >15) in an organized trauma system were explored using ordered logistic regression for the period October 2006 to June 2009. Data from the population-based Victorian State Trauma Registry were used.
  
  
  RESULTS
  There were 4986 patients older than 18 years. In-hospital mortality decreased from 11.9% in 2006-2007 to 9.9% in 2008-2009. The follow-up rate at 12 months was 86% (n = 3824). Eighty percent reported functional limitations. Odds of better functional outcome increased in the 2007-2008 [adjusted odds ratio (AOR): 1.22; 95% CI: 1.05, 1.41] and 2008-2009 (AOR: 1.16; 95% CI: 1.01, 1.34) years compared with 2006-2007. Cases managed at major trauma services (MTS) achieved better functional outcome (AOR: 1.22; 95% CI: 1.03, 1.45). Female gender, older age, and lower levels of education demonstrated lower adjusted odds of better outcome.
  
  
  CONCLUSIONS
  Despite an annual decline in mortality, risk-adjusted functional outcomes improved over time, and cases managed at MTS (level-1 trauma centers) demonstrated better functional outcomes. The findings provide early evidence that this inclusive, regionalized trauma system is achieving its aims.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia. belinda.gabbe@monash.edu
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.forename: Pam M
authors.initials: PM
authors.lastname: Simpson
authors.forename: Ann M
authors.initials: AM
authors.lastname: Sutherland
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Mark C
authors.initials: MC
authors.lastname: Fitzgerald
authors.forename: Rodney
authors.initials: R
authors.lastname: Judson
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012042:Registries; D014193:Trauma Centers / Q000458:organization & administration*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D055815:Young Adult