Fatality analysis reporting system demonstrates association between traumasystem initiatives and decreasing death rates

Trauma registries frequently do not include the deaths of patients who do n ot get to trauma centers (TCs), Thus, complementary methods of monitoring t he impact of trauma system initiatives should be considered, The objective of this study is to use National Highway Safety Traffic Administration's Fa tality Analysis Reporting System (FARS) and New York State Department of Mo tor Vehicles data and to study the impact of state and regional initiatives over a 10-year period in the seven-county Hudson Valley New York (HV) regi on with one regional TC in Westchester County (WC) and to assess its face v alidity. Methods: FARS data for the United States (US), New York State (NY), the HV region, and WC were analyzed from 1987 to 1996, Trauma system initiatives i ncluded the following, State-wide: (1) TC standards (1989), (2) TC designat ion and funding (1990), (3) State Trauma Advisory Committee (1991), (4) BLS triage protocol and trauma registry (1993), and (5) quality improvement si te surveys (1994), Regional: (1) one regional and two area TCs (1990), (2) helicopter services (1992 and 1994), (3) two additional area TCs, and (4)E 911 in all three counties (1995), The results were presented to the New Yor k State Trauma Advisory Committee, Results: Although nationally motor vehicle crash deaths/100,000 persons hav e plateaued since 1991, trauma system initiatives have been temporally asso ciated with death rates continuing to diminish in New York, the HV, and WC, From 1987 to 1996, the HV death rate dropped from 17.00 to 9.45, a 44% dro p; and the WC rate dropped from 12.51 to 7.05, a 44% drop compared with Uni ted States death rate drop of 16% (p < 0.005), The percentage of seriously injured trauma patients going to the trauma centers increased from 53 % in 1990 to 72% in 1995 (p < 0.001), The STAC felt that the data reflected in p art effects of New York State trauma system initiatives, Conclusion: The drops in motor vehicle crash death rates may reflect injury prevention as well as trauma system initiatives. Thus, although FARS and N ew York State Department of Motor Vehicles data cannot establish cause and effect relationships, it can monitor the aggregated impact of multiple init iatives. Taken together with increasing percentages of seriously injured tr auma patients going to trauma centers and comparisons with national FARS da ta, the association of decreasing deaths with the implementation of a traum a system seems to have face validity.