title: Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems.
abstract: BACKGROUND
  Trauma systems were developed to improve the care for the injured. The designation and elements comprising these systems vary across countries. In this study, we have compared the demographic patterns and patient outcomes of Level I trauma centers in three international trauma systems.
  
  
  METHODS
  International multicenter prospective trauma registry-based study, performed in the University Medical Center Utrecht (UMCU), Utrecht, the Netherlands, John Hunter Hospital (JHH), Newcastle, Australia, and Harborview Medical Center (HMC), Seattle, the United States.
  
  
  METHODS
  patients ≥18 years, admitted in 2012, registered in the institutional trauma registry.
  
  
  RESULTS
  In UMCU, JHH, and HMC, respectively, 955, 1146, and 4049 patients met the inclusion criteria of which 300, 412, and 1375 patients with Injury Severity Score (ISS) > 15. Mean ISS was higher in JHH (13.5; p < 0.001) and HMC (13.4; p < 0.001) compared to UMCU (11.7). Unadjusted mortality: UMCU = 6.5 %, JHH = 3.6 %, and HMC = 4.8 %. Adjusted odds of death: JHH = 0.498 [95 % confidence interval (CI) 0.303-0.818] and HMC = 0.473 (95 % CI 0.325-0.690) compared to UMCU. HMC compared to JHH was 1.002 (95 % CI 0.664-1.514). Odds of death patients ISS > 15: JHH = 0.507 (95 % CI 0.300-0.857) and HMC = 0.451 (95 % CI 0.297-0.683) compared to UMCU. HMC = 0.931 (95 % CI 0.608-1.425) compared to JHH. TRISS analysis: UMCU: Ws = 0.787, Z = 1.31, M = 0.87; JHH, Ws = 3.583, Z = 6.7, M = 0.89; HMC, Ws = 3.902, Z = 14.6, M = 0.84.
  
  
  CONCLUSIONS
  This study demonstrated substantial differences across centers in patient characteristics and mortality, mainly of neurological cause. Future research must investigate whether the outcome differences remain with nonfatal and long-term outcomes. Furthermore, we must focus on the development of a more valid method to compare systems.
authors.affiliation: Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. a.c.gunning@umcutrecht.nl.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Gunning
authors.affiliation: Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Koen W W
authors.initials: KW
authors.lastname: Lansink
authors.affiliation: Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Karlijn J P
authors.initials: KJ
authors.lastname: van Wessem
authors.affiliation: Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, Australia.
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
authors.affiliation: Department of Pediatrics, Epidemiology, and Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.affiliation: Department of Trauma, Burns and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA.
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.affiliation: Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D003710:Demography; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D012042:Registries; D014193:Trauma Centers; D014481:United States