Effectiveness of state trauma systems in reducing injury’related mortality: A National Evaluation

A. Nathen, Gregory Jurkovich, F. Rivara, R. Maier

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The authors postulated that implementation of an organized system of trauma care would reduce injury-related mortality. In order to evaluate this hypothesis a national study was completed comparing injury mortality rates in states with and without a trauma system. Sources for information included the 1993 Inventory of Trauma Systems, Compressed Mortality Files of the National Center for Health Statistics and the Fatality Analysis Reporting System (FARS). All trauma systems (TS’s) in the inventory have at the minimum a legal authority, which involves the authority to designate trauma centers and to establish triage procedures that allow prehospital personnel to bypass nearer facilities. A total of 22 TS’s were implemented by 1995 and included in the study. Global injury mortality rates were lower in states with trauma systems. A reduction was also noted in deaths by unintentional injury. Motor vehicle crashes (MVC) account for the greatest majority of unintentional injuries and were found to have an 18% reduction of mortality in states with TS’s. The authors recognized that other factors might impact MVC related mortality that is separate from the presence of a trauma system. To analyze this age, speed limits, restraint laws and population distribution were evaluated. Higher speed limits were shown to have the highest increase in mortality; primary enforcement of restraint laws showed a significant reduction in risk of death; additionally, a beneficial effect of TS’s extended across all age groups. Other studies of regional TS’s have been done but are limited to single states or counties. This study has the advantages of a large sample size, geographic distribution of the states and the consideration given to other parameters that effect MVC related mortality. The limitations of this study include issues that could underestimate the effectiveness of trauma systems such as variations between states with and without trauma systems and the cross-sectional design gives no insight into the changes that occur with the evolution of trauma systems over time. Overall, the evaluation demonstrates that states with trauma systems have a 9% reduction in global injury mortality with the greatest effect evident in MVC’s. The substantial costs and personnel associated with trauma systems are relatively insignificant when compared to the potential lives saved and the productivity gains equivalent to millions of dollars.

Original languageEnglish (US)
JournalJournal of Trauma Nursing
Issue number2
StatePublished - Jan 1 2000
Externally publishedYes

ASJC Scopus subject areas

  • Emergency
  • Critical Care
  • Advanced and Specialized Nursing


Dive into the research topics of 'Effectiveness of state trauma systems in reducing injury’related mortality: A National Evaluation'. Together they form a unique fingerprint.

Cite this