title: Mortality in Canadian Trauma Systems: A Multicenter Cohort Study.
abstract: To measure the variation in trauma center mortality across Canadian trauma systems, assess the contribution of traumatic brain injury and thoracoabdominal injury to observed variations, and evaluate whether the presence of recommended trauma system components is associated with mortality.
  
  
  
  Injuries represent one of the leading causes of mortality, disability, and health care costs worldwide. Trauma systems have improved injury outcomes, but the impact of trauma system configuration on mortality is unknown.
  
  
  
  We conducted a retrospective cohort study of adults admitted for major injury to trauma centers across Canada (2006-2012). Multilevel logistic regression was used to estimate risk-adjusted hospital mortality and assess the impact of 13 recommended trauma system components.
  
  
  
  Of 78,807 patients, 8382 (10.6%) died in hospital including 6516 (78%) after severe traumatic brain injury and 749 (9%) after severe thoracoabdominal injury. Risk-adjusted mortality varied from 7.0% to 14.2% across provinces (P < 0.0001); 11.1% to 26.0% for severe traumatic brain injury (P < 0.0001), and 4.7% to 5.9% for thoracoabdominal injury (P = 0.2). Mortality decreased with increasing number of recommended trauma system elements; adjusted odds ratio = 0.93 (0.87-0.99).
  
  
  
  We observed significant variation in trauma center mortality across Canadian provinces, specifically for severe traumatic brain injury. Provinces with more recommended trauma system components had better patient survival. Results suggest that trauma system configuration may be an important determinant of injury mortality. A better understanding of which system processes drive optimal outcomes is required to reduce the burden of injury worldwide.
authors.affiliation: *Department of Social and Preventative Medicine, Université Laval, Québec, Canada †Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada ‡Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada §Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ¶Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), Institute for Public Health, University of Calgary, Calgary, Alberta, Canada ||Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta, Canada **Institut national d'excellence en santé et en services sociaux (INESSS), Québec, Canada ††Department of Surgery, Université Laval, Québec, Canada ‡‡Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Canada §§Division of General Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: David
authors.initials: D
authors.lastname: Evans
authors.forename: Sayed M
authors.initials: SM
authors.lastname: Hameed
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Yanchar
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Richard
authors.initials: R
authors.lastname: Simons
authors.forename: John
authors.initials: J
authors.lastname: Kortbeek
authors.forename: Gilles
authors.initials: G
authors.lastname: Bourgeois
authors.forename: Julien
authors.initials: J
authors.lastname: Clément
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.forename: Avery
authors.initials: A
authors.lastname: Nathens
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002170:Canada; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D020379:Risk Adjustment; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult