title: Trauma system regionalization improves mortality in patients requiring trauma laparotomy.
abstract: This study evaluates the impact of a regional trauma network (RTN) on patient survival, intensive care unit (ICU) length of stay, and hospital length of stay in patients who required trauma laparotomy.
  
  
  
  Patients who required trauma laparotomy from January 2008 to December 2013 were analyzed. Patients admitted during 2008-2009 and 2011-2013 were designated as pre-RTN and RTN groups, respectively. The primary outcome was mortality.
  
  
  
  A total of 569 patients were analyzed, 231 patients were pre-RTN, and 338 were in the RTN group. Overall, mean age was 35.7 ± 17.1 and median Injury Severity Score was 16 (25th-75th percentile: 9-26). The two groups were similar with regard to age, Injury Severity Score, Abbreviated Injury Scale abdomen, sex, and mechanism. Overall, there was a 35% relative reduction in mortality from the pre-RTN to RTN group (p = 0.035), and 30% more patients were triaged to a Level 1 trauma center in the RTN group (p < 0.001). Logistic regression showed that being in the RTN group was an independent predictor for survival (p = 0.026) with odds ratio of 0.53 (95% confidence interval, 0.30-0.93). Patients with penetrating trauma had a nonsignificant decrease in mortality and a reduction of 1 day of ICU stay (p = 0.001). Patients with blunt trauma had a significant reduction in mortality from 38% in the pre-RTN group to 23% in the RTN group (p = 0.017).
  
  
  
  This study focused on the unique patient population that required trauma laparotomies. It showed that trauma system regionalization led to a significant increase in the number of patients triaged to a Level 1 trauma center and reduction of ICU length of stay. More importantly, it demonstrated the benefit of regionalization by showing a significant reduction of hospital mortality in this critically injured patient population.
  
  
  
  Therapeutic study, level IV.
authors.affiliation: From the Case Western Reserve University School of Medicine (D.S.), Cleveland, Ohio; Department of Surgery (J.C.H., B.M.Z., J.A.C.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; and The Northern Ohio Trauma System (D.A., J.A.C.), Cleveland, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Schechtman
authors.forename: Jack C
authors.initials: JC
authors.lastname: He
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Zosa
authors.forename: Debra
authors.initials: D
authors.lastname: Allen
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Claridge
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007813:Laparotomy / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009820:Ohio / Q000453:epidemiology; D012041:Regional Medical Programs / Q000458:organization & administration*; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality* / Q000601:surgery*