PREFERENTIAL BENEFIT OF IMPLEMENTATION OF A STATEWIDE TRAUMA SYSTEM IN ONE OF 2 ADJACENT STATES

Background: Implementation of Oregon's trauma system was associated wi th a reduction in the risk of death for hospitalized injured patients. An alternative explanation for improved outcome, however, is favorabl e concurrent temporal trends, e.g., new technologies and treatments. P atients and Methods: To control for temporal trends, seriously injured hospitalized patients in Oregon and Washington were compared before e ither state had a trauma system (1985-1988) and when only the Oregon t rauma system had been implemented (1990-1993), The study group consist ed of hospitalized injured patients aged 16 to 79 years with one or mo re index injuries in six body regions, i.e., head, chest, spleen/liver , femur or pelvis fracture, and burns. Hospital discharge claims data were analyzed, converting International Classification of Diseases, Ni nth Revision, Clinical Modification, discharge diagnosis codes to Abbr eviated Injury Scale scores and Injury Severity Scores using a convers ion algorithm. Multivariate logistic regression models were used to es timate the differential risk-adjusted odds of death in Oregon compared with Washington after adjustment for demographics, injury type, and i njury severity. Results: Findings indicated no difference in the risk- adjusted odds of death between Oregon and Washington while both states functioned under an ad hoc trauma system (1985-1988). A significant r eduction in the risk of death, however, was noted in Oregon for patien ts with an index injury and an Injury Severity Score > 15 compared wit h Washington (adjusted odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.70-0.91) after trauma system implementation in Oregon (1990- 1993), Specifically, reductions in the risk of death were demonstrated for patients with head injuries (adjusted OR = 0.70, 95% CI = 0.59-0. 82) or liver/spleen injuries (adjusted OR = 0.73, 95% CI = 0.54-0.99). Conclusion: Assuming that the two states demonstrated similar concurr ent temporal trends, the findings support the conclusion that improved outcomes among injured patients in Oregon may be attributed to the in stitution of a statewide trauma system.