TRAUMA CENTER DESIGNATION - INITIAL IMPACT ON TRAUMA-RELATED MORTALITY

The movement towards trauma care regionalization in Quebec was initiat ed in 1990, with formal designation of three level I trauma centers in 1993, The purpose of this study is to evaluate the impact of trauma c enter designation on mortality. The study design is that of a two-coho rt study, one assembled during 1987 when designation was not in effect , and the other during the first 5 months of designation. The study fo cuses on patients that fulfilled the following criteria: i) arrived al ive at the hospital, and ii) were admitted, The outcome measures are a djusted mortality, and excess mortality as measured by the TRISS metho dology, A total of 158 patients treated in 1987, and 288 treated in 19 93, were identified, The mean age of the patients treated in 1993 was significantly higher (40.0, +/- 18.1), when compared with the 1987 gro up (30.9 +/- 18.1; p < 0.001), Patients in the 1987 cohort had a signi ficantly higher proportion of injuries caused by stabbing (p = 0.02), and a significantly lower proportion caused by falls (p = 0.003), The 1987 cohort had a higher rate of abdominal injuries (p = 0.0001), and external injuries (p = 0.0001), and a significantly lower rate of head or neck injuries (p = 0.003), and injuries to the extremities (p 0.00 01), The mean Injury Severity Score (ISS) for the 1987 cohort was 14.9 6 (+/- 12.36), and 15.49 (+/- 11.61) in 1993 (p = 0.65), The crude mor tality rate was 20% for 1987, and 10% for 1993, The crude odds ratio f or mortality in 1987 was 2.10 with 95% confidence intervals between 1. 22 and 3.62 (p = 0.006), The ISS-based z scores for these two cohorts were 3.62 (p 0.0002), and 0.68 (p = 0.49) respectively, The Standardiz ed Mortality Rates (95% confidence intervals) were 1.64 (1.10-2.53) fo r 1987, and 1.11 (0.75-1.59) for 1993, indicating a statistically sign ificant reduction In excess mortality (p < 0.05). Multiple Logistic Re gression, adjusting for patient age, ISS, body regions injured, and me chanism of injury, showed a significantly higher mortality risk for th e 1987 cohort (relative odds = 3.25, p = 0.009), These data show that the process of trauma center designation has significantly improved th e survival of the patients treated in these facilities, This is likely due to increased surgical staffing, nursing support, and availability of the required high level technology at the designated hospitals.