The association between trauma system and trauma center components and outcome in a mature regionalized trauma system

Moishe Liberman, David S. Mulder, Gregory Jurkovich, John S. Sampalis

Research output: Contribution to journalReview article

79 Citations (Scopus)

Abstract

Background. Regionalized trauma systems have been shown repeatedly to improve the outcome of seriously injured patients. However, we do not have data regarding which components of these systems have the most impact on outcome and to what degree. The objective of this study was to understand the association between various components that make up a trauma system and outcome. Methods. Surveys were administered to trauma directors at 59 hospitals in the province of Quebec, Canada. Data from the surveys were then linked with specific outcome variables obtained from a regionalized trauma database. Specific outcomes were assigned to trauma system- and in-hospital-based components after controlling for injury severity. Results. Over 4.8 years, 72,073 patients met inclusion criteria. Components found to affect survival after risk adjustment were prehospital notification (OR, 0.61; 95% CI, 0.39-0.94) and the presence of a performance improvement program in that hospital (OR, 0.44; 95% CI, 0.20-0.94). Increased patient volume was associated with a reduction in risk-adjusted mortality (OR, 0.98; 95% CI, 0.97-0.99). Tertiary trauma centers were also associated with a reduction in risk-adjusted mortality compared with both secondary and primary centers (OR, 0.68; 95% CI, 0.48-0.99). Conclusions. Improvements in outcome in a regionalized trauma system are secondary to a combination of elements, as well as to the interplay of these elements on each other. Prehospital notification protocols and performance improvement programs appear to be most associated with decreased risk-adjusted odds of death.

Original languageEnglish (US)
Pages (from-to)647-658
Number of pages12
JournalSurgery
Volume137
Issue number6
DOIs
StatePublished - Jun 1 2005
Externally publishedYes

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Trauma Centers
Wounds and Injuries
Risk Reduction Behavior
Risk Adjustment
Mortality
Quebec
Canada
Databases
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

The association between trauma system and trauma center components and outcome in a mature regionalized trauma system. / Liberman, Moishe; Mulder, David S.; Jurkovich, Gregory; Sampalis, John S.

In: Surgery, Vol. 137, No. 6, 01.06.2005, p. 647-658.

Research output: Contribution to journalReview article

Liberman, Moishe ; Mulder, David S. ; Jurkovich, Gregory ; Sampalis, John S. / The association between trauma system and trauma center components and outcome in a mature regionalized trauma system. In: Surgery. 2005 ; Vol. 137, No. 6. pp. 647-658.
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