Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation

Background Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the provinc...

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Veröffentlicht in:Canadian Journal of Surgery Jg. 55; H. 1; S. 8 - 14
Hauptverfasser: Tallon, John M., MD, MSc, Fell, Deshayne B., MSc, Karim, Saleema A., MHSA, MBA, Ackroyd-Stolarz, Stacy, PhD, Petrie, David, MD
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Canada CMA Joule Inc 01.02.2012
CMA Impact, Inc
Canadian Medical Association
Schlagworte:
Access control
Accidents, Traffic - mortality
Accidents, Traffic - statistics & numerical data
Adult
Care and treatment
Casualties
Collisions
Emergency medical services
Emergency Medical Services - organization & administration
Female
Follow-Up Studies
Head injuries
Health Plan Implementation
Hospital Mortality
Humans
Laws, regulations and rules
Male
Medical policy
Mortality
Multiple Trauma - mortality
Multiple Trauma - therapy
Nova Scotia
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prognosis
Regional Health Planning
Retrospective Studies
State Government
Studies
Surgery
Traffic accidents
Traffic accidents & safety
Trauma care
Trauma Centers - organization & administration
Nova Scotia
Nova Scotia Canada
ISSN:0008-428X, 1488-2310, 1488-2310
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Abstract Background Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation. Methods We identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993–1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003–2005 (postimplementation). Results Postimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [CI] 1.04–1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% CI 0.32–1.03), although this difference was not statistically significant. Conclusion Individuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors.
AbstractList Background: Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation. Methods: We identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993-1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003-2005 (postimplementation). Results: Postimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [Cl] 1.04-1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% Cl 0.32-1.03), although this difference was not statistically significant. Conclusion: Individuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors. Contexte : Les systemes de traumatologie parvenus a maturite ont evolue pour repondre a la morbidite et a la mortalite liees a un traumatisme majeur. Des etudes portant sur des systemes de traumatologie a maturite ont demontre une amelioration de la survie, specialement chez les victimes d'un traumatisme grave. De 1995 a 1998, la Nouvelle-Ecosse a implante un systeme panprovincial de traumatologie. Nous avons mesure le pourcentage des admissions a un centre de traumatologie tertiaire et le pourcentage des deces survenus a l'hopital chez les patients victimes d'un traumatisme majeur a la suite d'un accident de la circulation avant l'implantation de systemes provinciaux de traumatologie et 10 ans apres. Methodes : Nous avons trouve des patients victimes d'un traumatisme majeur ages de 16 ans et plus en utilisant les codes E relatifs aux accidents de la circulation tires des donnees representatives des demandes de paiement des hopitaux et des statistiques demographiques. Nous avons compare les personnes admises a l'hopital ou qui sont decedees des suites d'un accident de la circulation en 1993-1994 (avant l'implantation) a celles qui ont ete hospitalisees ou qui sont decedees en 2003-2005 (apres l'implantation). Resultats : Apres l'implantation, le nombre de personnes victimes d'un traumatisme grave hospitalisees d'abord en soins tertiaires a augmente de 9 %. Cette augmentation etait statistiquement significative meme apres correction en fonction de l'age, du traumatisme cranien et de la municipalite de residence (risque relatif [RR] 1,09, intervalle de confiance [IC] a 95 %, 1,04-1,14). La probabilite de mourir a l'hopital au cours de la periode qui a suivi l'implantation a diminue de 29 % (RR corrige 0,57, IC a 95 %, 0,32-1,03), meme si cette difference n'etait pas statistiquement significative. Conclusion : Les personnes victimes d'un traumatisme grave a la suite d'un accident de la circulation en Nouvelle-Ecosse etaient plus susceptibles d'etre admises en soins tertiaires apres l'implantation d'un systeme panprovincial de traumatologie. On a constate une tendance a la baisse de la mortalite, mais une recherche plus poussee s'impose afin de confirmer les bienfaits pour la survie et de definir d'autres facteurs qui y contribuent.
Background Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation. Methods We identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993–1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003–2005 (postimplementation). Results Postimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [CI] 1.04–1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% CI 0.32–1.03), although this difference was not statistically significant. Conclusion Individuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors.
Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation. We identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993-1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003-2005 (postimplementation). Postimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [CI] 1.04-1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% CI 0.32-1.03), although this difference was not statistically significant. Individuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors.
Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation. We identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993-1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003-2005 (postimplementation). Postimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [CI] 1.04-1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% CI 0.32-1.03), although this difference was not statistically significant. Individuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors.
Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation.BACKGROUNDMature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation.We identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993-1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003-2005 (postimplementation).METHODSWe identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993-1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003-2005 (postimplementation).Postimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [CI] 1.04-1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% CI 0.32-1.03), although this difference was not statistically significant.RESULTSPostimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [CI] 1.04-1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% CI 0.32-1.03), although this difference was not statistically significant.Individuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors.CONCLUSIONIndividuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors.
Audience Academic
Author Tallon, John M., MD, MSc
Fell, Deshayne B., MSc
Ackroyd-Stolarz, Stacy, PhD
Karim, Saleema A., MHSA, MBA
Petrie, David, MD
AuthorAffiliation Department of Emergency Medicine, Dalhousie University, Halifax, NS
Department of Surgery, Dalhousie University, Halifax, NS
Nova Scotia Trauma Program, Dalhousie University, Halifax, NS
Queen Elizabeth II Health Sciences Centre, Halifax, NS
Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, NS
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– name: Queen Elizabeth II Health Sciences Centre, Halifax, NS
– name: Department of Surgery, Dalhousie University, Halifax, NS
– name: Department of Emergency Medicine, Dalhousie University, Halifax, NS
– name: Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, NS
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/22269307$$D View this record in MEDLINE/PubMed
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COPYRIGHT 2012 CMA Joule Inc.
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– reference: 17610358 - J Neurotrauma. 2007 Jul;24(7):1189-97
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– reference: 17127121 - Surg Clin North Am. 2007 Feb;87(1):21-35, v-vi
– reference: 17159679 - J Trauma. 2006 Dec;61(6):1374-8; discussion 1378-9
– reference: 16427544 - J Am Coll Surg. 2006 Feb;202(2):212-5; quiz A45
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Snippet Background Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated...
Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved...
Background: Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated...
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SubjectTerms Access control
Accidents, Traffic - mortality
Accidents, Traffic - statistics & numerical data
Adult
Care and treatment
Casualties
Collisions
Emergency medical services
Emergency Medical Services - organization & administration
Female
Follow-Up Studies
Head injuries
Health Plan Implementation
Hospital Mortality
Humans
Laws, regulations and rules
Male
Medical policy
Mortality
Multiple Trauma - mortality
Multiple Trauma - therapy
Nova Scotia
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prognosis
Regional Health Planning
Retrospective Studies
State Government
Studies
Surgery
Traffic accidents
Traffic accidents & safety
Trauma care
Trauma Centers - organization & administration
Title Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation
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