title: The mortality risk from motor vehicle injuries in California has increased during the last decade.
abstract: BACKGROUND
  Organized trauma systems and trauma centers are thought to improve trauma outcomes. It is clear that injured patients who receive care in trauma centers have survival advantages. However, large regions of California still do not have access to trauma centers. Many injured patients in California continue to receive their care in nontrauma center hospitals. The purpose of this study was to compare outcomes in California counties with and without trauma centers. In addition, we wished to query the efficacy of the current statewide trauma system by asking whether mortality after motor vehicle trauma in California has improved during the last decade.
  
  
  METHODS
  We performed a retrospective outcome study. The California highway patrol provided data from all motor vehicle crashes (MVCs) and mortality during the years 1999 to 2008 for the 58 counties in California. Percent fatality was calculated as the number of motor vehicle fatalities divided by the number of injuries. Data were analyzed to compare outcomes in counties with and without trauma centers. Furthermore, demographic data were studied to analyze the relationship of population and hospital density on mortality.
  
  
  RESULTS
  Mortality was significantly lower in counties with trauma centers. Low population and hospital density independently correlated with increased mortality. Injury mortality rates after MVCs increased during the decade both in counties with and without trauma centers.
  
  
  CONCLUSIONS
  Overall, the presence of a trauma center improved the chances of survival after an MVC in California counties. However, mortality rates after injuries increased during the decade both in counties with and without trauma centers. Future efforts to improve outcomes for injured patients in California will require new approaches, which must include improving both access to trauma centers and the care provided in nontrauma center hospitals.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: Department of Surgery, Ventura County Health System, Ventura, California 93003, USA. kenneth.waxman@ventura.org
authors.forename: Kenneth
authors.initials: K
authors.lastname: Waxman
authors.forename: Seema
authors.initials: S
authors.lastname: Izfar
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grotts
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002140:California; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D015999:Multivariate Analysis; D020380:Needs Assessment; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D055815:Young Adult