THE IMPACT OF A DEDICATED TRAUMA PROGRAM ON OUTCOME IN SEVERELY INJURED PATIENTS

Background: In recent years, many trauma centers have been closing or scaling down their operations because of financial losses and lack of commitment by the relevant authorities. Objective: To investigate the effect of commitment to trauma and the establishment of a dedicated tr auma program on injury outcome. Design: In 1992, a well-funded dedicat ed trauma program was implemented at the Los Angeles County-University of Southern California Medical Center, Los Angeles. We analyzed the o utcome in severely injured patients (Injury Severity Score [ISS] >15) before and after implementation of the program (1991 and 1993). Settin g: Large, urban, level 1 trauma center. Patients: Patients with trauma and an ISS higher than 15. Results: There were 737 patients with an I SS higher than 15 in 1991 and 812 patients with an ISS higher than 15 in 1993. The overall mortality rate was 30% in 1991 and 24.5% in 1993 (P=.018), which is a reduction by 18.3%. In patients with blunt trauma and an ISS higher than 15, mortality was reduced by 33% (mortality ra te of 31.1% in 1991 vs 20.8% in 1993) (P<.002). Mortality in patients with penetrating trauma and an ISS higher than 30 was reduced by 42.7% (mortality rate of 59.3% in 1991 vs 34% in 1993) (P=.019). There was also a trend toward lower permanent disabilities among survivors with an ISS higher than 15 (14.7% in 1991 vs 11.3% in 1993). Conclusion: Co mmitment of financial and human resources for the establishment of a d edicated trauma program is a sound investment in terms of improved sur vival and fewer permanent disabilities in critically injured patients.