An Evaluation of Patient Outcomes before and after Trauma Center Designation Using Trauma and Injury Severity Score Analysis

Abstract

In June 1990, the Ministry of Health designated 11 hospitals throughout Ontario to be lead hospitals in trauma care. An integral part of a trauma system is the evaluation of care, in particular, outcome of the trauma patients. The Trauma and Injury Severity Score (TRISS) methodology, which offers a standard approach for evaluating outcomes for different populations of trauma patients, was used to determine if there was an improvement in outcomes after the designation of trauma centers of patients involved in motor vehicle crashes (ICD-9-CM, E810.0-825.9), with an Injury Severity Score > 12 for two 12-month periods: one predesignation (1989/1990) and one postdesignation (1992/1993). The Revised Trauma Score, Injury Severity Score, age, and outcome were calculated or abstracted from the hospital chart of each patient at the trauma center. The probability of survival of each patient, the z- and W-statistics of both years were calculated. A measurable improvement was shown in z-statistics between the 2 years from z = -0.40 predesignation to z = +0.72 postdesignation. When the bias introduced by patients intubated before arrival at the trauma center being excluded from TRISS analysis was removed, using a TRISS-like (as per Offner et al: J. Trauma 32:32, 1992) logistic regression equation that allows analysis of intubated patients, the improvement was even greater, with z = +1.34 predesignation and z = +2.97 postdesignation. Only the statistically significant z-score of the postdesignated year required the W-score to be calculated, W = +5.60.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality Reduction in Major Trauma Patients after Establishment of a Level I Trauma Center in Korea: A Single-Center Experience

“…Numerous studies in developed countries have demonstrated an association between the establishment of level I trauma centers and decreased mortality following major trauma. A TRISS-like analysis of Stewart's study revealed a significant increase in the Z-score from +1.34 pre-designation to +2.97 post-designation [14]. Champion et al [15] found that an increased institutional commitment to excellence in trauma care and the establishment of a trauma system in the hospital area were associated with significantly improved outcomes among trauma patients.…”

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.…”

Recommendations for the Establishment of Stroke Systems of Care

“…Local and regional trauma systems are effective in decreasing traumarelated morbidity and mortality. [17][18][19][20][21][22][23][24][25][26][27] Despite being based on similar principles, a number of important differences exist between the organization of trauma care and that of stroke care. These differences are such that simply designating trauma systems as stroke systems would be inappropriate.…”