The Effect of Regionalization upon the Quality of Trauma Care as Assessed by Concurrent Audit before and after Institution of a Trauma System: A Preliminary Report

The Effect of Organized Systems of Trauma Care on Motor Vehicle Crash Mortality

“…For example, one study reported a greater than 50% reduction in the proportion of deaths deemed potentially preventable prior to and following regional system implementation. 22 Although these data suggest a marked and rapid improvement in outcome associated with the development of a regional trauma system, the assessment of preventability requires judgments by a panel regarding the appropriateness of care and salvageability. In the study mentioned above and other similar studies, the preventable death fraction is calculated by excluding prehospital deaths and patients dead on arrival, precluding any assessment of prehospital care and/or resuscitation.…”

The Canadian Forces trauma care system

“…They found that mortality was reduced by 8% after adjusting for possible confounders, including other secular trends in crash mortality. Likewise, Shackford and colleagues 9 reported a greater than 50% reduction in the proportion of deaths deemed potentially preventable before and after trauma system development. More recently, Mullins and colleagues 10 evaluated the outcome of hospitalized patients after the organization of trau ma care in Oregon and found a 35% reduction in mortality within 2 years after implementation.…”

Needed Dialog

“…There is overwhelming evidence demonstrating that modern, regionalized trauma systems have improved injuryrelated mortality by using this paradigm. [48][49][50][51][52][53][54][55][56][57][58][59] Furthermore, there are data suggesting that patients treated at level-1 centers also have improved functional outcomes after an injury, 60-62 with higher patient volumes associated with better outcomes. 63 It is generally thought that the marked improvements in morbidity and mortality with regionalized trauma systems are secondary to more patients with the most severe injuries being treated at level-1 trauma centers and because of a reduction in the time from injury to definitive treatment through rapid triage and transport.…”