RESUMEN
BACKGROUND: The impact of implementing an inclusive state trauma system on injury-related mortality for patients with life-threatening injuries was assessed. METHODS: Using the state trauma registry, trauma patients evaluated in all of Delaware's acute care hospitals from 1998 to 2007 were identified. Patients were categorized by injury severity score (ISS) groups (1-9, 10-15, 16-24, and >24). Each category was analyzed by mortality and interfacility transfer rate to the Level I trauma center for each year. An analysis of the National Trauma Data Bank (NTDB) for these ISS groups and mortality was performed to provide a comparative benchmark. Chi(2) and analysis of variance were used where appropriate (p
Asunto(s)
Causas de Muerte , Mortalidad Hospitalaria , Centros Traumatológicos/organización & administración , Traumatología/organización & administración , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapia , Adulto , Terapia Combinada , Cuidados Críticos/organización & administración , Delaware , Servicios Médicos de Urgencia/organización & administración , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Sistema de Registros , Análisis de Supervivencia , Heridas y Lesiones/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: In 2000, Delaware instituted a trauma system that included establishing four Level III trauma centers in counties previously without trauma centers. The purpose of this study was to analyze whether implementation of this inclusive trauma system reduced the injury-related mortality rates in these counties. METHODS: Using the state trauma registry, patients with trauma admitted to all acute care hospitals in Delaware from January 1, 1995 through December 31, 2004 were identified and categorized into two groups: preimplementation of an inclusive trauma system (1995-1999), and postimplementation (2000-2004). These groups were compared in aggregate and by individual counties for age, sex, mechanism of injury, Abbreviated Injury Score, injury-related mortality rate, mean Injury Severity Score (ISS), acute transfers out, and acute transfers in (Level I only). chi test and Mann-Whitney U test were used where indicated. Significance was determined to be p < or = 0.05. RESULTS: After implementation, mortality rates significantly decreased (5.3%-2.8%) and rate of acute transfers out increased (14.7%-19.5%) in the counties served by the Level III centers. The ISS of patients in the Level I trauma center significantly increased (mean ISS = 10) when compared with the Level III trauma centers (mean ISS = 6), reflecting increased transfers of patients with severe injuries. CONCLUSION: An inclusive state trauma system that included the establishment of Level III trauma centers in previously underserved counties led to a decrease in trauma-related mortality rates in these counties. In the county served by the Level I trauma center, mortality remained unchanged despite an increase in admissions and the injury severity of these admissions.