title: An analysis of the effectiveness of a state trauma system: treatment at designated trauma centers is associated with an increased probability of survival.
abstract: BACKGROUND
  States struggle to continue support for recruitment, funding and development of designated trauma centers (DTCs). The purpose of this study was to evaluate the probability of survival for injured patients treated at DTCs versus nontrauma centers.
  
  
  METHODS
  We reviewed 188,348 patients from the state's hospital discharge database and identified 13,953 severely injured patients admitted to either a DTC or a nontrauma center between 2008 and 2012. DRG International Classification of Diseases-9th Rev. Injury Severity Scores (ICISS), an accepted indicator of injury severity, was assigned to each patient. Severe injury was defined as an ICISS less than 0.85 (indicating ≥15% probability of mortality). Three subgroups of the severely injured patients were defined as most critical, intermediate critical, and least critical. A full information maximum likelihood bivariate probit model was used to determine the differences in the probability of survival for matched cohorts.
  
  
  RESULTS
  After controlling for injury severity, injury type, patient demographics, the presence of comorbidities, as well as insurance type and status, severely injured patients treated at a DTC have a 10% increased probability of survival. The largest improvement was seen in the intermediate subgroup.
  
  
  CONCLUSIONS
  Treatment of severely injured patients at a DTC is associated with an improved probability of survival. This argues for continued resources in support of DTCs within a defined statewide network.
  
  
  METHODS
  Epidemiologic study, level III.
authors: From the Department of Surgery (D.W.A., T.J.J.), Medical Center Navicent Health and Mercer University School of Medicine, Macon; Departments of Surgery (R.S.M.), and Physiological and Technological Nursing (E.G.N.), Georgia Regents University, Augusta; and Department of Surgery (E.V.A.), Grady Memorial Hospital (J.M.N.); and Department of Surgery (J.M.N.), Emory University School of Medicine, Atlanta, Georgia; Department of Healthcare Policy and Research (E.E.P.), University of South Florida College of Public Health, Tampa, Florida.
authors: Dennis W
authors: DW
authors: Ashley
authors: Etienne E
authors: EE
authors: Pracht
authors: Regina S
authors: RS
authors: Medeiros
authors: Elizabeth V
authors: EV
authors: Atkins
authors: Elizabeth G
authors: EG
authors: NeSmith
authors: Tracy J
authors: TJ
authors: Johns
authors: Jeffrey M
authors: JM
authors: Nicholas
mesh_terms: D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D010043:Outcome and Process Assessment, Health Care; D011336:Probability; D016019:Survival Analysis; D014193:Trauma Centers / Q000592:standards*; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*