Trauma center designation: Initial impact on trauma-related mortality

J. S. Sampalis, A. Lavoie, S. Boukas, H. Tamim, A. Nikolis, P. Frechette, R. Brown, D. Fleiszer, R. Denis, E. Bergeron, D. Mulder, D. D. Trunkey, J. S. Smith, A. B. Eastman, J. Hammond, P. Angood, Michael L Hawkins, J. A. Mendelson, C. G. Cayten, R. S. Smith

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

The movement towards trauma care regionalization in Quebec was initiated in 1990, with formal designation of three level I trauma centers in 1993. The purpose of this study is to evaluate the impact of trauma center designation on mortality. The study design is that of a two-cohort study, one assembled during 1987 when designation was not in effect, and the other during the first 5 months of designation. The study focuses on patients that fulfilled the following criteria: i) arrived alive at the hospital, and ii) were admitted. The outcome measures are adjusted mortality, and excess mortality as measured by the TRISS methodology. A total of 158 patients treated in 1987, and 288 treated in 1993, were identified. The mean age of the patients treated in 1993 was significantly higher (40.0, ± 18.1), when compared with the 1987 group (30.9 ± 18.1; p < 0.001). Patients in the 1987 cohort had a significantly higher proportion of injuries caused by stabbing (p = 0.02), and a significantly lower proportion caused by falls (p = 0.003). The 1987 cohort had a higher rate of abdominal injuries (p = 0.0001), and external injuries (p = 0.0001), and a significantly lower rate of head or neck injuries (p = 0.003), and injuries to the extremities (p = 0.0001). The mean Injury Severity Score (ISS) for the 1987 cohort was 14.96 (± 12.36), and 15.49 (± 11.61) in 1993 (p = 0.65). The crude mortality rate was 20% for 1987, and 10% for 1993. The crude odds ratio for mortality in 1987 was 2.10 with 95% confidence intervals between 1.22 and 3.62 (p = 0.006). The ISS- based z scores for these two cohorts were 3.62 (p = 0.0002), and 0.68 (p = 0.49) respectively. The Standardized Mortality Rates (95% confidence intervals) were 1.64 (1.102.53) for 1987, and 1.11 (0.75-1.59) for 1993, indicating a statistically significant reduction in excess mortality (p < 0.05). Multiple Logistic Regression, adjusting for patient age, ISS, body regions injured, and mechanism of injury, showed a significantly higher mortality risk for the 1987 cohort (relative odds = 3.25, p = 0.009). These data show that the process of trauma center designation has significantly improved the survival of the patients treated in these facilities. This is likely due to increased surgical staffing, nursing support, and availability of the required high level technology at the designated hospitals.

Original languageEnglish (US)
Pages (from-to)232-239
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume39
Issue number2
DOIs
StatePublished - Sep 12 1995

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Trauma Centers
Mortality
Wounds and Injuries
Injury Severity Score
Odds Ratio
Perioperative Nursing
Confidence Intervals
Neck Injuries
Abdominal Injuries
Body Regions
Quebec
Craniocerebral Trauma
Cohort Studies
Extremities
Logistic Models
Outcome Assessment (Health Care)
Technology
Survival

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Sampalis, J. S., Lavoie, A., Boukas, S., Tamim, H., Nikolis, A., Frechette, P., ... Smith, R. S. (1995). Trauma center designation: Initial impact on trauma-related mortality. Journal of Trauma - Injury, Infection and Critical Care, 39(2), 232-239. https://doi.org/10.1097/00005373-199508000-00008

Trauma center designation : Initial impact on trauma-related mortality. / Sampalis, J. S.; Lavoie, A.; Boukas, S.; Tamim, H.; Nikolis, A.; Frechette, P.; Brown, R.; Fleiszer, D.; Denis, R.; Bergeron, E.; Mulder, D.; Trunkey, D. D.; Smith, J. S.; Eastman, A. B.; Hammond, J.; Angood, P.; Hawkins, Michael L; Mendelson, J. A.; Cayten, C. G.; Smith, R. S.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 39, No. 2, 12.09.1995, p. 232-239.

Research output: Contribution to journalArticle

Sampalis, JS, Lavoie, A, Boukas, S, Tamim, H, Nikolis, A, Frechette, P, Brown, R, Fleiszer, D, Denis, R, Bergeron, E, Mulder, D, Trunkey, DD, Smith, JS, Eastman, AB, Hammond, J, Angood, P, Hawkins, ML, Mendelson, JA, Cayten, CG & Smith, RS 1995, 'Trauma center designation: Initial impact on trauma-related mortality', Journal of Trauma - Injury, Infection and Critical Care, vol. 39, no. 2, pp. 232-239. https://doi.org/10.1097/00005373-199508000-00008
Sampalis, J. S. ; Lavoie, A. ; Boukas, S. ; Tamim, H. ; Nikolis, A. ; Frechette, P. ; Brown, R. ; Fleiszer, D. ; Denis, R. ; Bergeron, E. ; Mulder, D. ; Trunkey, D. D. ; Smith, J. S. ; Eastman, A. B. ; Hammond, J. ; Angood, P. ; Hawkins, Michael L ; Mendelson, J. A. ; Cayten, C. G. ; Smith, R. S. / Trauma center designation : Initial impact on trauma-related mortality. In: Journal of Trauma - Injury, Infection and Critical Care. 1995 ; Vol. 39, No. 2. pp. 232-239.
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AU - Sampalis, J. S.

AU - Lavoie, A.

AU - Boukas, S.

AU - Tamim, H.

AU - Nikolis, A.

AU - Frechette, P.

AU - Brown, R.

AU - Fleiszer, D.

AU - Denis, R.

AU - Bergeron, E.

AU - Mulder, D.

AU - Trunkey, D. D.

AU - Smith, J. S.

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AU - Hammond, J.

AU - Angood, P.

AU - Hawkins, Michael L

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AU - Smith, R. S.

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