title: The evolution of trauma surgery at a high-volume Canadian centre: implications for public health, prevention, clinical care, education and recruitment.
abstract: BACKGROUND
  Trauma centres continue to evolve with respect to clinical care and their impact on public health. Despite improvements in patient outcomes, operative volumes, and therefore maintenance of surgical skills, has become a challenging issue. We sought to determine whether injury demographics and treatments at a high-volume centre changed over time.
  
  
  METHODS
  We used the Alberta Trauma Registry to analyze all severely injured (injury severity score [ISS] ≥ 12) patient admissions over a 16-year period (1995-2011).
  
  
  RESULTS
  Of the 12,879 severely injured patients requiring admission, there was a 1.5- fold increase in the annual admission rate despite population normalization (p = 0.001). Over the 16-year interval, patients were older with a subsequent lower mortality (p = 0.001) and length of hospital stay (p = 0.007). In patients with the most severe ISS (≥ 48), there was no change in mortality (27%, p = 0.26). In 2011, falls were the most common mechanism compared with motor vehicle crashes (41% v. 23%; p < 0.001); this was a complete reversal compared with 1995 (25% v. 41%). Motorized recreational vehicle and motorcycle injuries also increased (p < 0.001). The mean number of operations performed by trauma surgeons decreased (laparotomies: 67 [17%] in 1995 v. 47 [5%] in 2011, p < 0.001). Thoracotomies and tracheostomies remained unchanged (p = 0.19).
  
  
  CONCLUSIONS
  Clinical care has improved despite an increasing overall volume of severely injured patient admissions. The number of operative interventions performed by trauma surgeons continues to decrease concurrent to a change in injury mechanisms. Despite these improvements, maintenance of technical skills among trauma surgeons has become an important issue.
authors.affiliation: The Departments of Surgery and the Regional Trauma Services, University of Calgary and the Foothills Medical Centre, Calgary, Alta.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: The Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alta.
authors.forename: Debanjana
authors.initials: D
authors.lastname: Das
authors.affiliation: The Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alta.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: The Department of Regional Trauma Services, University of Calgary and the Foothills Medical Centre, Calgary, Alta.
authors.forename: Christine
authors.initials: C
authors.lastname: Vis
authors.affiliation: The Departments of Surgery and the Regional Trauma Services, University of Calgary and the Foothills Medical Centre, Calgary, Alta.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: The Departments of Surgery, Regional Trauma Services, and Critical Care Medicine, University of Calgary and the Foothills Medical Centre, Calgary, Alta.
authors.forename: John B
authors.initials: JB
authors.lastname: Kortbeek
mesh_terms: D000059:Accidents; D000328:Adult; D000367:Age Factors; D000416:Alberta / Q000453:epidemiology; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D016014:Linear Models; D010343:Patient Admission / Q000706:statistics & numerical data; D012042:Registries; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data / Q000639:trends*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*