OUTCOMES AFTER SEVERE TRAUMA AT A NORTHERN CANADIAN REGIONAL TRAUMA CENTER

OBJECTIVE: To evaluate outcomes of trauma patients at a northern commu nity trauma referral centre that does not meet several of the guidelin es for a trauma centre. DESIGN: A retrospective study. SETTING: Sudbur y General Hospital in northern Ontario. PARTICIPANTS: All trauma patie nts admitted between 1991 and 1994 who had an Injury Severity Score (I SS) greater than 12. OUTCOME MEASURES: Actual survival to discharge wa s compared to survival predicted by TRISS analysis. Z, W and M scores were calculated by standard TRISS techniques. RESULTS: Of 526 patients with an ISS greater than 12, 416 (79%) were suitable for TRISS analys is. Of these 416 patients, 310 (74%) were men. The mean age was 39 yea rs. Two hundred and sixty-one (63%) patients were admitted directly to the Sudbury General Hospital, whereas 155 (37%) were transferred from other hospitals. The leading causes of injury were motor vehicle-traf fic accidents in 48%, motor vehicle-nontraffic in 21% and falls in 8%. Overall, there were more unexpected survivors than patients who died. The Z score for survivors was 4.95, and the W score was 5.66. CONCLUS IONS:In the setting of a geographically isolated, medium-volume trauma centre where blunt injuries predominate, excellent trauma survival ca n be achieved without meeting all trauma centre guidelines for staffin g and facilities. Relaxing stringent requirements for the availability of physicians may facilitate surgical recruitment and retention.