title: Influence of access to an integrated trauma system on in-hospital mortality and length of stay.
abstract: BACKGROUND
  Few data are available on population-based access to specialised trauma care and its influence on patient outcomes in an integrated trauma system. We aimed to evaluate the influence of access to an integrate trauma system on in-hospital mortality and length of stay (LOS).
  
  
  METHODS
  All adults admitted to acute care hospitals for major trauma [International Classification of Diseases Injury Severity Score (ICISS<0.85)] in a Canadian province with an integrated trauma system between 2006 and 2011 were included using an administrative hospital discharge database. The influence of access to an integrated trauma system on in-hospital mortality and LOS was assessed globally and for critically injured patients (ICISS<0.75), according to the type of injury [traumatic brain injury (TBI), abdominal/thoracic, spine, orthopaedic] using logistic and linear multivariable regression models.
  
  
  RESULTS
  We identified 22,749 injury admissions. In-hospital mortality was 7% and median LOS was 9 days for all injuries. Overall, 92% of patients were treated within the trauma system. Globally, patients who did not have access had similar mortality and LOS compared to patients who had access. However, we observed a 62% reduction in mortality for critical abdominal/thoracic injuries (odds ratio=0.38; 95% CI, 0.16-0.92) and an 8% increase in LOS for TBI patients (geometric mean ratio=1.08; 95% CI, 1.02-1.14) treated within the trauma system.
  
  
  CONCLUSIONS
  Results provides evidence that in a health system with an integrated mature trauma system, access to specialised trauma care is high and the small proportion of patients treated outside the system, have similar mortality and LOS compared to patients treated within the system. This study suggests that the Québec trauma system performs well in its mandate to offer appropriate treatment to victims of injury that require specialised care.
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada; Institut National de Santé Publique du Québec, QC, Canada. Electronic address: brice-lionel.batomen-kuimi.1@ulaval.ca.
authors: Brice L Batomen
authors: BL
authors: Kuimi
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada.
authors: Lynne
authors: L
authors: Moore
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada.
authors: Brahim
authors: B
authors: Cissé
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada; Institut National de Santé Publique du Québec, QC, Canada.
authors: Mathieu
authors: M
authors: Gagné
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada.
authors: André
authors: A
authors: Lavoie
authors: Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada.
authors: Gilles
authors: G
authors: Bourgeois
authors: Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada.
authors: Jean
authors: J
authors: Lapointe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011792:Quebec / Q000453:epidemiology; D014193:Trauma Centers / Q000458:organization & administration* / Q000592:standards; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Access to care; Injury; Length of stay; Mortality; Trauma system