title: Does the Institution of a Statewide Trauma System Reduce Preventable Mortality and Yield a Positive Return on Investment for Taxpayers?
abstract: BACKGROUND
  In July 2009, Arkansas began to annually fund $20 million for a statewide trauma system (TS). We studied injury deaths both pre-TS (2009) and post-TS (2013 to 2014), with attention to causes of preventive mortality, societal cost of those preventable mortality deaths, and benefit to tax payers of the lives saved.
  
  
  METHODS
  A multi-specialty trauma-expert panel met and reviewed records of 672 decedents (290 pre-TS and 382 post-TS) who met standardized inclusion criteria, were judged potentially salvageable, and were selected by a proportional sampling of the roughly 2,500 annual trauma deaths. Deaths were adjudicated into sub-categories of nonpreventable and preventable causes. The value of lives lost was calculated for those lives potentially saved in the post-TS period.
  
  
  RESULTS
  Total preventable mortality was reduced from 30% of cases pre-TS to 16% of cases studied post-TS, a reduction of 14%. Extrapolating a 14% reduction of preventable mortality to the post-TS study period, using the same inclusion criteria of the post-TS, we calculate that 79 lives were saved in 2013 to 2014 due to the institution of a TS. Using a minimal standard estimate of $100,000 value for a life-year, a lifetime value of $2,365,000 per person was saved. This equates to an economic impact of the lives saved of almost $186 million annually, representing a 9-fold return on investment from the $20 million of annual state funding invested in the TS.
  
  
  CONCLUSIONS
  The implementation of a TS in Arkansas during a 5-year period resulted in a reduction of the preventable death rate to 16% post-TS, and a 9-fold return on investment by the tax payer. Additional life-saving gains can be expected with ongoing financial support and additional system performance-improvement efforts.
authors.forename: Todd
authors.initials: T
authors.lastname: Maxson
authors.forename: Charles D
authors.initials: CD
authors.lastname: Mabry
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sutherland
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Robertson
authors.forename: James O
authors.initials: JO
authors.lastname: Booker
authors.forename: Terry
authors.initials: T
authors.lastname: Collins
authors.forename: Horace J
authors.initials: HJ
authors.lastname: Spencer
authors.forename: Charles F
authors.initials: CF
authors.lastname: Rinker
authors.forename: Teri L
authors.initials: TL
authors.lastname: Sanddal
authors.forename: Nels D
authors.initials: ND
authors.lastname: Sanddal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001131:Arkansas / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007449:Investments; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D013660:Taxes; D014193:Trauma Centers / Q000458:organization & administration*; D026712:Value of Life / Q000191:economics; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult