PROGRESS IN THE DEVELOPMENT OF TRAUMA SYSTEMS IN THE UNITED-STATES - RESULTS OF A NATIONAL SURVEY

Objective.-To examine the status of trauma system development and key structural and operational characteristics of these systems. Design an d Setting.-National survey of trauma systems with enabling state statu te, regulation, or executive orders and for which designated trauma ce nters were present. Participants.-Trauma system administrators and dir ectors of 37 state and regional organizations that had legal authority to administer trauma systems, which represented a response rate of 90 .2%. Main Outcome Measures.-Trauma system components that had been imp lemented or were under development. Results.-From 1988 to 1993, the nu mber of states meeting one set of criteria for a complete trauma syste m criteria increased from two to five. The most common deficiency in e stablishing trauma systems was failure to limit the number of designat ed trauma centers based on community need. Although most existing trau ma systems have developed formal processes for designating trauma cent ers, prehospital triage protocols to allow hospital bypass, and centra lized trauma registries, several systems lack standardized policies fo r interhospital transfer and systemwide evaluation. Conclusion.-State and regional organizations have accomplished a great deal but still ha ve substantial work ahead in developing comprehensive trauma systems. Research is needed to better understand the relationship between traum a volume and outcomes of care as well as the impact of trauma system s tructure and operational characteristics on care delivery. Improved me asures of patient outcome are also needed so that effective system eva luation can take place.