title: Evolution of patient outcomes over 14 years in a mature, inclusive Canadian trauma system.
abstract: BACKGROUND
  The introduction of trauma systems in many countries worldwide has been shown to improve injury survival. However, few data are available on the long-term evolution of outcomes other than mortality. The objective of this study was to describe trends in mortality, unplanned readmission, complications, and length of stay in a mature inclusive trauma system from 1999 to 2012.
  
  
  METHODS
  This retrospective cohort study was based on the inclusive trauma system of Quebec, Canada. Data were drawn from the trauma registry linked to the hospital discharge database. Time trends were evaluated using generalized linear mixed models with a correction for hospital clusters and cohort effects.
  
  
  RESULTS
  Between 1999 and 2012, risk-adjusted mortality decreased from 5.8 to 4.2% for all patients and from 14.9 to 13.1% for major trauma (p < 0.0001). Mean LOS decreased from 9.5 days to 8.0 days for all patients and from 15.5 days to 11.5 days for major trauma (p < 0.0001). Unplanned readmission and complication rates remained stable over the observation period at around 6.6 and 11.6% for all patients and 7.6 and 25.6% for major trauma, respectively.
  
  
  CONCLUSIONS
  The results of this study suggest that there have been significant decreases in patient mortality and hospital length of stay in the inclusive trauma system of Québec over the last decade. Results also suggest that efforts should be made to reduce in-hospital complications and unplanned readmissions. Future research should attempt to identify determinants of observed decreases in mortality and LOS and assess whether similar improvements have occurred in functional outcomes.
authors: Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada, lynne.moore@fmed.ulaval.ca.
authors: Lynne
authors: L
authors: Moore
authors: Alexis F
authors: AF
authors: Turgeon
authors: François
authors: F
authors: Lauzier
authors: Marcel
authors: M
authors: Émond
authors: Simon
authors: S
authors: Berthelot
authors: Julien
authors: J
authors: Clément
authors: Gilles
authors: G
authors: Bourgeois
authors: Jean
authors: J
authors: Lapointe
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality*
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