The effect of organized systems of trauma care on motor vehicle crash mortality

Context Despite calls for wider national implementation of an integrated ap proach to trauma care, the effectiveness of this approach at a regional or state level remains unproven. Objective To determine whether implementation of an organized system of tra uma care reduces mortality due to motor vehicle crashes. Design Cross-sectional time-series analysis of crash mortality data collect ed for 1979 through 1995 from the Fatality Analysis Reporting System. Setting All 50 US states and the District of Columbia. Subjects All front-seat passenger vehicle occupants aged 15 to 74 years. Main Outcome Measures Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimat es are based on within-state comparisons adjusted for national trends in cr ash mortality. Results Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma s ystem implementation, mortality was reduced by 8% (95% confidence interval [CI], 3%-12%) after adjusting for secular trends in crash mortality, age, a nd the introduction of traffic safety laws. Implementation of primary enfor cement of restraint laws and laws deterring drunk driving resulted in reduc tions in crash mortality of 13% (95% CI, 11%-16%)and 5% (95% CI, 3%-7%), re spectively, while relaxation of state speed limits increased mortality by 7 % (95% CI, 3%-10%). Conclusions Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 yea rs, a finding consistent with the maturation and development of trauma tria ge protocols, interhospital transfer agreements, organization of trauma cen ters, and ongoing quality assurance.