title: The contribution of the Israeli trauma system to the survival of road traffic casualties.
abstract: BACKGROUND
  According to the World Health Organization, over one million people die annually from traffic crashes, in which over half are pedestrians, bicycle riders and two-wheel motor vehicles. In Israel, during the last decade, mortality from traffic crashes has decreased from 636 in 1998 to 288 in 2011. Professionals attribute the decrease in mortality to enforcement, improved infrastructure and roads and behavioral changes among road users, while no credit is given to the trauma system. Trauma systems which care for severe and critical casualties improve the injury outcomes and reduce mortality among road casualties.
  
  
  OBJECTIVE
  1) To evaluate the contribution of the Israeli Health System, especially the trauma system, on the reduction in mortality among traffic casualties. 2) To evaluate the chance of survival among hospitalized traffic casualties, according to age, gender, injury severity and type of road user.
  
  
  METHODS
  A retrospective study based on the National Trauma Registry, 1998-2011, including hospitalization data from eight hospitals.
  
  
  RESULTS
  During the study period, the Trauma Registry included 262,947 hospitalized trauma patients, of which 25.3% were due to a road accident. During the study period, a 25% reduction in traffic related mortality was reported, from 3.6% in 1998 to 2.7% in 2011. Among severe and critical (ISS 16+) casualties the reduction in mortality rates was even more significant, 41%; from 18.6% in 1998 to 11.0% in 2011. Among severe and critical pedestrian injuries, a 44% decrease was reported (from 29.1% in 1998 to 16.2% in 2011) and a 65% reduction among bicycle injuries. During the study period, the risk of mortality decreased by over 50% from 1998 to 2011 (OR 0.44 95% 0.33-0.59. In addition, a simulation was conducted to determine the impact of the trauma system on mortality of hospitalized road casualties. Presuming that the mortality rate remained constant at 18.6% and without any improvement in the trauma system, in 2011 there would have been 182 in-hospital deaths compared to the actual 108 traffic related deaths. A 41% difference was noted between the actual number of deaths and the expected number.
  
  
  CONCLUSIONS
  This study clearly shows that without any improvement in the health system, specifically the trauma system, the number of traffic deaths would be considerably greater. Although the health system has a significant contribution on reducing mortality, it does not receive the appropriate acknowledgment or resources for its proportion in the fight against traffic accidents.
authors.affiliation: a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Goldman
authors.forename: Maya
authors.initials: M
authors.lastname: Siman-Tov
authors.forename: H
authors.initials: H
authors.lastname: Bahouth
authors.forename: B
authors.initials: B
authors.lastname: Kessel
authors.forename: Y
authors.initials: Y
authors.lastname: Klein
authors.forename: M
authors.initials: M
authors.lastname: Michaelson
authors.forename: B
authors.initials: B
authors.lastname: Miklosh
authors.forename: A
authors.initials: A
authors.lastname: Rivkind
authors.forename: G
authors.initials: G
authors.lastname: Shaked
authors.forename: D
authors.initials: D
authors.lastname: Simon
authors.forename: D
authors.initials: D
authors.lastname: Soffer
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
keywords: driver; injury; injury outcome; mortality; motorcycle; pedestrian; road traffic; trauma system