The effect of organized systems of trauma care on motor vehicle crash mortality

Avery B. Nathens, Gregory Jurkovich, Peter Gummings, Frederick P. Rivara, Ronald V. Maier

Research output: Contribution to journalArticle

314 Citations (Scopus)

Abstract

Context: Despite calls for wider national implementation of an integrated approach to trauma care, the effectiveness of this approach at a regional or state level remains unproven. Objective: To determine whether implementation of an organized system of trauma care reduces mortality due to motor vehicle crashes. Design: Cross-sectional time-series analysis of crash mortality data collected for 1979 through 1995 from the Fatality Analysis Reporting System. Setting: All 50 US states and the District of Columbia. Subjects: All front-seat passenger vehicle occupants aged 15 to 74 years. Main Outcome Measures: Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimates are based on within-state comparisons adjusted for national trends in crash mortality. Results: Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma system implementation, mortality was reduced by 8% (95% confidence interval [CI], 3%-12%) after adjusting for secular trends in crash mortality, age, and the introduction of traffic safety laws. Implementation of primary enforcement of restraint laws and laws deterring drunk driving resulted in reductions in crash mortality of 13% (95% CI, 11%-16%) and 5% (95% CI, 3%- 7%), respectively, while relaxation of state speed limits increased mortality by 7% (95% CI, 3%-10%). Conclusions: Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 years, a finding consistent with the maturation and development of trauma triage protocols, interhospital transfer agreements, organization of trauma centers, and ongoing quality assurance.

Original languageEnglish (US)
Pages (from-to)1990-1994
Number of pages5
JournalJournal of the American Medical Association
Volume283
Issue number15
DOIs
StatePublished - Apr 19 2000
Externally publishedYes

Fingerprint

Motor Vehicles
Mortality
Wounds and Injuries
Confidence Intervals
Transfer Agreement
Law Enforcement
Triage
Trauma Centers
Outcome Assessment (Health Care)
Organizations
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The effect of organized systems of trauma care on motor vehicle crash mortality. / Nathens, Avery B.; Jurkovich, Gregory; Gummings, Peter; Rivara, Frederick P.; Maier, Ronald V.

In: Journal of the American Medical Association, Vol. 283, No. 15, 19.04.2000, p. 1990-1994.

Research output: Contribution to journalArticle

Nathens, Avery B. ; Jurkovich, Gregory ; Gummings, Peter ; Rivara, Frederick P. ; Maier, Ronald V. / The effect of organized systems of trauma care on motor vehicle crash mortality. In: Journal of the American Medical Association. 2000 ; Vol. 283, No. 15. pp. 1990-1994.
@article{3072cc564665414a966e5c3891a00a06,
title = "The effect of organized systems of trauma care on motor vehicle crash mortality",
abstract = "Context: Despite calls for wider national implementation of an integrated approach to trauma care, the effectiveness of this approach at a regional or state level remains unproven. Objective: To determine whether implementation of an organized system of trauma care reduces mortality due to motor vehicle crashes. Design: Cross-sectional time-series analysis of crash mortality data collected for 1979 through 1995 from the Fatality Analysis Reporting System. Setting: All 50 US states and the District of Columbia. Subjects: All front-seat passenger vehicle occupants aged 15 to 74 years. Main Outcome Measures: Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimates are based on within-state comparisons adjusted for national trends in crash mortality. Results: Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma system implementation, mortality was reduced by 8{\%} (95{\%} confidence interval [CI], 3{\%}-12{\%}) after adjusting for secular trends in crash mortality, age, and the introduction of traffic safety laws. Implementation of primary enforcement of restraint laws and laws deterring drunk driving resulted in reductions in crash mortality of 13{\%} (95{\%} CI, 11{\%}-16{\%}) and 5{\%} (95{\%} CI, 3{\%}- 7{\%}), respectively, while relaxation of state speed limits increased mortality by 7{\%} (95{\%} CI, 3{\%}-10{\%}). Conclusions: Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 years, a finding consistent with the maturation and development of trauma triage protocols, interhospital transfer agreements, organization of trauma centers, and ongoing quality assurance.",
author = "Nathens, {Avery B.} and Gregory Jurkovich and Peter Gummings and Rivara, {Frederick P.} and Maier, {Ronald V.}",
year = "2000",
month = "4",
day = "19",
doi = "10.1001/jama.283.15.1990",
language = "English (US)",
volume = "283",
pages = "1990--1994",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "15",

}

TY - JOUR

T1 - The effect of organized systems of trauma care on motor vehicle crash mortality

AU - Nathens, Avery B.

AU - Jurkovich, Gregory

AU - Gummings, Peter

AU - Rivara, Frederick P.

AU - Maier, Ronald V.

PY - 2000/4/19

Y1 - 2000/4/19

N2 - Context: Despite calls for wider national implementation of an integrated approach to trauma care, the effectiveness of this approach at a regional or state level remains unproven. Objective: To determine whether implementation of an organized system of trauma care reduces mortality due to motor vehicle crashes. Design: Cross-sectional time-series analysis of crash mortality data collected for 1979 through 1995 from the Fatality Analysis Reporting System. Setting: All 50 US states and the District of Columbia. Subjects: All front-seat passenger vehicle occupants aged 15 to 74 years. Main Outcome Measures: Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimates are based on within-state comparisons adjusted for national trends in crash mortality. Results: Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma system implementation, mortality was reduced by 8% (95% confidence interval [CI], 3%-12%) after adjusting for secular trends in crash mortality, age, and the introduction of traffic safety laws. Implementation of primary enforcement of restraint laws and laws deterring drunk driving resulted in reductions in crash mortality of 13% (95% CI, 11%-16%) and 5% (95% CI, 3%- 7%), respectively, while relaxation of state speed limits increased mortality by 7% (95% CI, 3%-10%). Conclusions: Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 years, a finding consistent with the maturation and development of trauma triage protocols, interhospital transfer agreements, organization of trauma centers, and ongoing quality assurance.

AB - Context: Despite calls for wider national implementation of an integrated approach to trauma care, the effectiveness of this approach at a regional or state level remains unproven. Objective: To determine whether implementation of an organized system of trauma care reduces mortality due to motor vehicle crashes. Design: Cross-sectional time-series analysis of crash mortality data collected for 1979 through 1995 from the Fatality Analysis Reporting System. Setting: All 50 US states and the District of Columbia. Subjects: All front-seat passenger vehicle occupants aged 15 to 74 years. Main Outcome Measures: Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimates are based on within-state comparisons adjusted for national trends in crash mortality. Results: Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma system implementation, mortality was reduced by 8% (95% confidence interval [CI], 3%-12%) after adjusting for secular trends in crash mortality, age, and the introduction of traffic safety laws. Implementation of primary enforcement of restraint laws and laws deterring drunk driving resulted in reductions in crash mortality of 13% (95% CI, 11%-16%) and 5% (95% CI, 3%- 7%), respectively, while relaxation of state speed limits increased mortality by 7% (95% CI, 3%-10%). Conclusions: Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 years, a finding consistent with the maturation and development of trauma triage protocols, interhospital transfer agreements, organization of trauma centers, and ongoing quality assurance.

UR - http://www.scopus.com/inward/record.url?scp=0034685419&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034685419&partnerID=8YFLogxK

U2 - 10.1001/jama.283.15.1990

DO - 10.1001/jama.283.15.1990

M3 - Article

C2 - 10789667

AN - SCOPUS:0034685419

VL - 283

SP - 1990

EP - 1994

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 15

ER -