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PubMed2002

Prehospital intubation in severe thoracic trauma without respiratory insufficiency: a matched-pair analysis based on the Trauma Registry of the German Trauma Society.

OBJECTIVE: On the basis of the data of a multicenter study, the impact of prehospital intubation and ventilation in the therapy of severe thoracic trauma without manifest respiratory insufficiency was analyzed. METHODS: Data were collected prospectively in the Trauma Registry of the German Trauma Society. In a matched-pair analysis, patients with severe thoracic trauma (Abbreviated Injury Scale score of 4) with and without prehospital intubation were compared. Patients were paired with respect to age, injury severity, and prognosis (according to the TRISS method). RESULTS: From a total of 3,814 patients, two groups (with/without prehospital intubation) of 44 matched patients each with comparable average age (36 vs. 36 years), Injury Severity Score (29 vs. 29), and TRISS (95.2 vs. 95.3) were identified. No patient was unconscious at the scene (all Glasgow Coma Scale scores > or = 8) or presented with severe respiratory insufficiency (all > or = 10 breaths/min). Time between injury and hospital admission was significantly longer (73 minutes; p < 0.05) in the group with prehospital intubation compared with the nonintubated group (47 minutes). Furthermore, fluid requirements in the prehospital period were significantly higher in the intubated patients (3,000 mL vs. 1,000 mL). In the prehospital intubation group, the number of patients with mass transfusion (9 vs. 4) as well as with emergency operations (10 vs. 4) were not significantly different from the nonintubated group. The prehospital intubation group showed a similar incidence of lung failure (17 vs. 14), kidney failure (6 vs. 2), and circulation failure (13 vs. 5). Except for two of the primarily nonintubated patients, all were intubated during their stay in the emergency room or on the intensive care unit. Days of ventilation (median, 7 days) as well as the length of stay on the ICU (median, 11 days) were comparable in both groups. Mortality in the prehospital intubation group was not significantly different between groups (six vs. two deceased). CONCLUSION: Prognosis with respect to organ failure, treatment time, and mortality is not adversely affected in the German trauma system, if patients with severe thoracic trauma without manifest respiratory insufficiency and without other indications for intubation are not treated with prehospital intubation.

Adult↗
PubMed1989

Trauma score versus revised trauma score in TRISS to predict outcome in children with blunt trauma.

We analyzed the accuracy of TRISS and a revised TRISS to predict survival outcome in a group of 1,562 consecutive children less than 15 years old admitted with blunt trauma to a pediatric trauma center. TRISS is an index that computes a probability of survival for each patient based on Trauma Score, Injury Severity Score, and age. R-TRISS uses the Revised Trauma Score instead of the Trauma Score. We used a statistical method based on TRISS and R-TRISS to compare patient outcomes from the pediatric study group with those of an adult baseline control group from the Major Trauma Outcome Study. Both TRISS and R-TRISS have the capability to accurately quantify survival outcome for children with blunt trauma; there was no statistical difference between the two methods to do so.

Adolescent↗
PubMed2005

Evaluation of criteria for temporary external fixation in risk-adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients: "evidence-based medicine" versus "reality" in the trauma registry of the German Trauma Society.

BACKGROUND: Femur-shaft fracture treatment (FSFT) follows controversial management concepts after multiple trauma: primary-definitive osteosynthesis, secondary-definitive osteosynthesis after temporary external fixation (EF) in all patients, or individualized primary- or secondary-definitive osteosynthesis ("risk-adapted damage control orthopedics"). This study compares the concepts by analyzing literature evidence and a prospective multicenter database. METHODS: A systematic literature analysis was performed. The German Trauma Society trauma registry was used to assess variables predictive of treatment concept. RESULTS: Contradictory results in 63 controlled trials failed to support a "generalized management strategy." In all, 1,465 FSFTs in 8,057 trauma registry patients (age 39 +/- 19.5 years; Injury Severity Score [ISS] 23.5 +/- 14.9; 17.3% mortality) were treated initially (<24 hour) by EF, nail, or plate in 47.0%, 41.1%, and 11.9%, respectively. Despite large interhospital variability, EF was more likely with increasing severity of ISS, Glasgow Coma Score, thorax trauma, base excess, coagulation abnormalities, and initial probability of death. CONCLUSIONS: Clinical "reality" reflects the controversies of "scientific evidence" for FSFT after multiple trauma in Germany. Although decision making is currently based on unvalidated criteria, anatomic and physiologic injury severity appears to influence the choice of management concept.

Adolescent↗
PubMed1990

Update on trauma care in Canada. 6. Update on trauma registries and trauma scoring.

Developments in microcomputer technology and user friendly software have resulted in rapidly expanding interest in trauma registries and injury scoring. The trauma registry, particularly when it is population based, is an empowering tool for epidemiologic research, planning of trauma systems, development of prevention programs, outcome evaluation and research. Injury coding performed in conjunction with trauma registry can also provide the basis for institutional quality assurance. The Major Trauma Outcome Study has played a major role in this, through the development of normative standards, permitting inter-institutional comparisons. These issues as well as some of the present Canadian and American initiatives in the trauma registry field are reviewed in this paper. Advances in injury scaling are addressed as are some of the limitations in existing coding methodologies.

Databases, Factual↗
PubMedDate not supplied

Trauma center versus non-trauma center admissions in adult trauma victims by age and gender.

OBJECTIVE: The admission types and appropriateness of admission of adults with differing levels of injury severity were compared, based on patient age and gender. METHODS: This retrospective study used a statewide hospital discharge dataset. The patients included adults who had sustained trauma related to motor vehicles and were admitted to trauma center (TCs) and non-trauma center (NTCs) hospitals. Using injury severity scores (ISSs) >or= 16 to denote major trauma, the proportion of patients with major traumatic injuries who were admitted to TCs and NTCs was determined. Types of admission (TC versus NTC) were compared by age and gender for four subgroups of men and women, aged 25 to 64 years, and aged 65 years and older. RESULTS: The sample included 5,712 patients. Of those patients with ISS >or= 16, younger men were most likely to be admitted to a TC (82%), and older women were least likely to be admitted to a TC (60%). The proportions of older men and women with ISS >or= 16 who were admitted to a TC were comparable. Among patients with ISS < 16 admitted to NTCs, older women were the highest proportion (65%), and younger men were the lowest proportion (43%). Overall, more older men and women with ISS >or= 16 were admitted to NTCs than would have been expected. Conversely, a statistically significant proportion of younger men and women with ISS<16 were admitted to TCs. CONCLUSION: Findings suggest that older trauma victims whose injuries appear to be serious are admitted to NTCs more often than are younger trauma victims with similarly serious injuries. Additional studies to examine this phenomenon are warranted.

Accidents, Traffic↗
PubMed1978

Host defense against opportunist microorganisms following trauma. II. Changes in complement and immunoglobulins in patients with abdominal trauma and in septic patients without trauma.

Total hemolytic complement (CH50), conversion of C3 by inulin and cobra venom factor (CoVF), and immunochemical levels of Clq, C4, C2, C3, C5, factor B, properdin, C3b inactivator (KAF), and immunoglobulins (Igs) G, A, and M were measured in the sera of ten patients with abdominal trauma and ten medical patients with septicemia without trauma. Reduction in C3 conversion by CoVF and decrease in the levels of properdin and KAF were demonstrated in the trauma sera. CH50 and the level of C5 were also decreased. Conversion of C3 by inulin and levels of factor B, Clq, C4, C2, and C3 were found to be normal in the patients' sera. Complement levels and activities were found to be normal in the sera of the septic non-trauma patients. A decrease in serum IgM was observed in both patient groups; levels of IgG and IgA were normal. These results indicated that abnormalities of immunoglobulin and of the alternative and classical complement pathways were associated with nonburn trauma. Moreover, the data suggested that consumption of the classical complement pathway associated with septicemia in the thermally injured patient resulted from synergism between the trauma and infection rather than from septicemia per se.

Abdominal Injuries↗
PubMed2007

The accuracy of focused assessment with sonography in trauma (FAST) in blunt trauma patients: experience of an Australian major trauma service.

UNLABELLED: Focused assessment with sonography for trauma (FAST) is a method for detecting haemoperitoneum in trauma patients on initial assessment in the Emergency Department. The aim of this paper is to present an Australian trauma centre's experience with FAST as a tool to screen for intraabdominal free fluid in patient's sustaining blunt truncal trauma. METHOD: Over a 63-month period, FAST scans were prospectively studied and compared with findings from a gold-standard investigation, either computed tomography (CT) or laparotomy. RESULTS: 463 FAST results were collected prospectively from 463 patients. 53 scans were excluded due to lack of a corresponding confirmatory gold-standard test. Overall sensitivity, specificity, positive and negative predictive values for FAST in detecting free fluid were 78%, 97%, 91%, 93%, respectively. Analysis of the credentialed operators demonstrated an improvement in accuracy (sensitivity 80%, specificity 100%, positive predictive value 100%, negative predictive value 94%). These findings are comparable with documented international experience. CONCLUSION: The study demonstrates that the use of non-radiologist performed FAST in the detection of free fluid is safe and accurate within an Australian Trauma Centre.

Adolescent↗
PubMed2002

Risk of death among cases attending South Australian major trauma services after severe trauma: the first 4 years of operation of a state trauma system.

BACKGROUND: Factors predictive of death at South Australian major trauma services were investigated among 8,654 patients who had experienced severe trauma from 1997 to 2000. METHOD: Univariate and multivariate analyses of age, sex, injury severity, presence of comorbid conditions, and calendar year of presentation were performed. RESULTS: Multiple logistic regression indicated that factors predictive of death were older age; higher injury severity as indicated by the New Injury Severity Score and the Revised Trauma Score; and accompanying chronic liver disease, ischemic heart disease, and chronic renal failure. A decrease in risk of death by calendar year was statistically significant (p = 0.001). Using 1997 as the reference, the relative odds of death were 0.86 (95% confidence limits) (0.53, 1.39) for 1998, 0.60 (0.36, 0.99) for 1999, and 0.45 (0.27, 0.76) for 2000. CONCLUSION: Results show a decrease in risk of death of patients attending South Australian major trauma services, from injuries of equivalent severity, during the first 4 years of operation of the State Trauma System.

Adolescent↗
PubMed1998

Employment of trauma and injury severity score and a severity characterization of trauma in the outcome evaluation of trauma care and their research advances.

OBJECTIVE: To review the application of trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) in the outcome evaluation of trauma care and their research advances. DATA SOURCES: Both Chinese- and English-language literature searched by using MEDLINE/CD-ROM (1985-1996) and Index of Chinese-Language Literature (1985-1996). STUDY SELECTION: Over fifty papers and reviews published over the past ten years were selected. RESULTS AND CONCLUSION: TRISS can be employed for different purposes, that is, preliminary outcome-based evaluation (PRE) and definitive outcome-based evaluation (DEF). TRISS is a method which is now the most extensively used for the outcome evaluation of trauma. Even so, it still has some shortcomings, e.g., trauma can not be given the weights that should be given, and the section of age is too simple. ASCOT is also a physiologic and anatomic combined method for the evaluation of injury severity and outcome. To some extent, this method obviates the shortcomings of TRISS in the calculation of probability of survival (Ps) with injury severity score (ISS). Therefore, ASCOT is considered to be superior to TRISS in the evaluation of Ps. However, TRISS is still now more extensively used than ASCOT just because ASCOT was recently developed.

Humans↗
PubMed2000

[The Trauma Registry of the German Society of Trauma Surgery as a basis for interclinical quality management. A multicenter study of the German Society of Trauma Surgery].

Based on the "Trauma Registry" of the German Society of Trauma Surgery, an interclinical quality management (QM) system was implemented. The principles of the QM system as well as the differences in the quality of outcome and treatment are presented. The analysis uses the data on 2,069 severely injured (ISS = 22 +/- 14) patients from 20 hospitals collected prospectively and anonymously between 2/93 and 12/97. Outcome quality was analyzed by the TRISS method and Z-statistics. The Z-value of the whole series was -0.24. There were three hospitals with more than 150 patients that had a Ps value calculated by the TRISS method. Clinic A had a good (-2.49), clinic B an average (-0.3) and clinic C (3.62) an adverse Z-value. The assessment of treatment quality was performed by criteria concerning both preclinical and acute clinical phases. Clinic C had a prolonged preclinical treatment time (90 min vs 62 min in clinic A) for severely injured (ISS > 15) patients. At the same time, the preclinical intubation rate for severe thoracic trauma (AIS > 3) was lower (44 %) in clinic C than in A (62 %). With 14 min clinic A had the shortest time until basic radiological and ultrasound diagnostics were completed (X-rays of chest and pelvis and abdominal ultrasound) in cases of severe blunt trauma (ISS > 15), compared to 54 min in clinic B or 31 min in clinic C. Also, cranial computed tomography for severe traumatic brain injury (GCS < 9) was applied significantly faster in clinic A (after 36 min) than in clinic C (after 62 min). Delayed diagnoses were defined as the difference between the ISS at discharge and the ISS at completion of diagnostics in the emergency department; this criterion was met best by clinic A with an ISS difference of two patients compared to five in clinic B and four in clinic C. The hospitals participating in the Trauma Registry receive an annual analysis of their preclinical and acute clinical performance. Thus, every hospital can analyze and improve the quality of treatment based on reliable data that show which parts of the process have to be optimized. Furthermore, the data allow a comparison of the average and optimal results of the whole series.

Efficiency, Organizational↗
PubMed2001

Trauma outcome analysis of a Jakarta University Hospital using the TRISS method: validation and limitation in comparison with the major trauma outcome study. Trauma and Injury Severity Score.

BACKGROUND: In this prospective study, the TRISS methodology is used to compare trauma care at a University Hospital in Jakarta, Indonesia, with the standards reported in the Major Trauma Outcome Study (MTOS). METHODS: Between February 24, 1999, and July 1, 1999, all consecutive patients with multiple and severe trauma were included in the study (n = 105). Survival analysis was completed for 97 (92%) patients. RESULTS: The majority of patients were men (81%), and the average age was 28 years. Ninety-five patients (98%) sustained blunt trauma, with motor vehicle crashes being the most common (68%). The predicted mortality was 14% and the observed mortality was 29%. The Z and M statistics were 7.87 and 0.843, respectively. CONCLUSION: We conclude that in developing countries both institution-bound factors and specific limitations in the TRISS methodology are responsible for the difference between predicted and observed mortality, indicating the need for a regional database.

Adolescent↗
PubMed1989

A comparison of the trauma score, the revised trauma score, and the pediatric trauma score.

We compared the abilities of the Trauma Score (TS), the Revised Trauma Score (RTS), and the Pediatric Trauma Score (PTS) to retrospectively identify severely injured children. TS, RTS, and PTS were computed on admission for 1,334 consecutive blunt and penetrating trauma victims 0 to 14 years old. Injury Severity Score values of more than 15 and 20 or more were used as the criteria indicating severe injury. Sensitivity, specificity, and positive and negative predictive values were computed. Threshold values were determined for each scale to maximize sensitivity and specificity. No significant differences were found between the TS and the PTS. After adjusting for rapid respirations among children 0 to 3 years old, no differences existed between the RTS and the other scores. TS of less than 15, RTS of less than 12, and PTS of less than 9 are equally sensitive and specific indicators for pediatric prehospital triage. Because of the similarity of the instruments tested, their performances in other areas, such as quality assurance, should be considered when selecting a pediatric triage tool.

Adolescent↗
PubMed2002

[Psychological trauma in trauma medicine--the current status of psychological management of trauma victims in Germany].

A clinically significant amount of accident victims display psychological disorders as a reaction to the trauma. Outcome studies on multiple trauma emphasize that life quality following severe accidental injury is influenced by early diagnosis and treatment of psychic co-morbidity. In a nationwide survey concerning the state of the art in in-patient treatment of injury patients conducted in Germany, every surgical ward was contacted and physicians were asked about their standard procedures of detecting and treating psychotraumatic complications. The results of the survey indicate that surgeons pay close attention to signs of psychological comorbidity and have good basic knowledge of psychotraumatic disorders. Nevertheless, there are structural deficiencies caused by the fact that only a few wards have staff specially trained in psychotraumatological care. Only a minority of patients is treated for psychotraumatic symptoms. In view of the high prevalence rates for psychotraumatic disorders in the aftermath of severe accidental injuries, the article discusses the need for psychic diagnosis and support as well as the necessary cooperative structures required in the model of Integrative Posttraumatic Acute Care.

Germany↗
PubMed1999

Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims.

OBJECTIVE: Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emergency department (ED) for trauma victims by organizing a formal trauma response system. DESIGN: A case-control study of severely injured children, comparing those who received treatment before and after the creation of a formal trauma response team. SETTING: A tertiary pediatric referral hospital that is a locally designated pediatric trauma center, and also receives trauma victims from a geographically large area of the Western United States. SUBJECTS: Pediatric trauma victims identified as critically injured (designated as "trauma one") and treated by a hospital trauma response team during the first year of its existence. Control patients were matched with subjects by probability of survival scores, and were chosen from pediatric trauma victims treated at the same hospital during the year preceding the creation of the trauma team. INTERVENTIONS: A trauma response team was organized to respond to pediatric trauma victims seen in the ED. The decision to activate the trauma team (designation of patient as "trauma one") is made by the pediatric emergency medicine (PEM) physician before patient arrival in the ED, based on data received from prehospital care providers. Activation results in the notification and immediate travel to the ED of a pediatric surgeon, neurosurgeon, emergency physician, intensivist, pharmacist, radiology technician, phlebotomist, and intensive care unit nurse, and mobilization of an operating room team. Most trauma one patients arrived by helicopter directly from accident scenes. OUTCOME MEASURES: Data recorded included identifying information, diagnosis, time to head computerized tomography, time required for ED treatment, admission Revised Trauma Score, discharge Injury Severity Score, surgical procedures performed, and mortality outcome. Trauma Injury Severity Score methodology was used to calculate the probability of survival and mortality compared with the reference patients of the Major Trauma Outcome Study, by calculation of z score. RESULTS: Patients treated in the ED after trauma team initiation had statistically shorter times from arrival to computerized tomography scanning (27 +/- 2 vs 21 +/- 4 minutes), operating room (63 +/- 16 vs 623 +/- 27 minutes) and total time in the ED (85 +/- 8 vs 821 +/- 9 minutes). Calculation of z score showed that survival for the control group was not different from the reference population (z = -0.8068), although survival for trauma-one patients was significantly better than the reference population (z = 2.102). CONCLUSION: Before creation of the trauma team, relevant specialists were individually called to the ED for patient evaluation. When a formal trauma response team was organized, time required for ED treatment of severe trauma was decreased, and survival was better than predicted compared with the reference Major Trauma Outcome Study population.

Case-Control Studies↗
PubMed2002

Relative importance of designation and accreditation of trauma centers during evolution of a regional trauma system.

BACKGROUND: Improved survival after injury has been demonstrated with trauma system implementation and designation of trauma centers. Local designating health authorities or national verification (United States) or accreditation (Canada) programs audit trauma center performance. The relative importance of designation versus accreditation with respect to improved outcomes is not clear. The purpose of this study was to measure outcomes within a single regional trauma system after designation of trauma centers and to compare outcomes in the one accredited center to the nonaccredited centers. METHODS: Data from three trauma centers were studied. All were large, university-affiliated regional medical centers, integrated into a regional trauma system and served by a single ambulance service. The study period was 1992 to 1999, immediately after trauma center designation in 1991. The British Columbia Trauma Registry was used to identify trauma patients, mechanism of injury, length of stay, case mix, case volume, acuity, pediatric caseload, and proportion of transfers at each center. A questionnaire was circulated to each hospital to determine the level of institutional support and programmatic development for trauma. The Trauma Registry was used to calculate z scores (TRISS methodology) for each center and TRISS-adjusted mortality odds ratios between institutions. Differences in covariables were controlled for in subgroup analysis. RESULTS: Two centers (hospitals A and C) had a high trauma caseload; one (hospital B) had a small and diminishing caseload. Only one center (hospital A) developed a trauma program consistent with Canadian accreditation criteria; z scores for center A were consistently better than at hospital B or C and survival odds ratios were significant. This finding applied to the total trauma population, blunt adult trauma patients (whether or not transfers and hip fracture patients were excluded), and in the more severely injured blunt trauma subgroups. There were no differences between hospitals for the relatively small number of patients with penetrating trauma. CONCLUSION: Differences between hospitals were apparent from the outset of the trauma system. However, designation as a trauma center does not appear to necessarily improve survival in large regional medical centers. Development of a trauma program and commitment to meeting national guidelines through the accreditation process does appear to be associated with improved outcome after injury.

Accreditation↗
PubMed2004

Trauma stat and trauma minor: are we making the call appropriately?

OBJECTIVES: Trauma accounts for a significant number of pediatric emergency room visits and is the leading cause of death in pediatric patients over 1 year of age. To provide quality care, protocols are used to mobilize personnel to treat injured patients. We reviewed our experience at a level 1 pediatric trauma center, where a 2-tiered trauma activation protocol is used in treating children with significant injuries. METHODS: We analyzed data in our trauma registry from 1994 to 1999 of patients with Injury Severity Score > or = 9 in whom trauma activations were called. Data reflected demographics, severity of injury, hospital course and outcome. Trauma activations were based on standard protocols that took physiologic status, anatomic area of injury, and mechanism of injury into account. Nineteen personnel were notified in a Trauma Stat Activation, and 8 were notified in a Trauma Minor Activation. RESULTS: There were 470 trauma activations: Trauma Stat = 220 and Trauma Minor = 250. As a group, Trauma Stat patients were more hemodynamically unstable, had a lower GCS and a higher Injury Severity Score than Trauma Minor patients. Patients in the Trauma Stat group were also more likely to require intensive care and have a prolonged hospitalization. The Trauma Stat group had a mortality rate of 20%. There were no deaths in the Trauma Minor group. CONCLUSIONS: Trauma activations result in heavy resource utilization and must be appropriate. The 2 trauma activation levels were associated with differences in injury severity, medical resource utilization, and outcome. With no deaths in the Trauma Minor group and a 20% mortality rate in the Trauma Stat group, we conclude that the protocol used was neither too conservative, nor too liberal.

Adolescent↗
PubMed2000

Vascular trauma at a military level II trauma center(1).

As members of an American College of Surgeons Committee on Trauma-designated level II trauma center, we decided to review our experience with vascular trauma. In addition, we sought to characterize the vascular injuries presented and to compare our outcomes to the general trauma population.A review of all vascular trauma admissions from January 1997 through January 2000 was performed. The William Beaumont Army Medical Center (WBAMC) trauma registry data base was searched for vascular injuries utilizing 3 different search criteria: organ system, operation/procedure, and ICD-9 codes. Injuries were then characterized by age, gender, site of injury, injury severity score (ISS), mechanism, and need for surgery. Mortality rates were computed for both vascular and nonvascular trauma populations. Statistical analysis of the data was determined by Student t test and z score.Between January 1997 and January 2000, there were 1398 patients admitted to the trauma service at WBAMC. Of these, 48 patients (3.4%) had vascular injuries. The mean ISS for all nonvascular traumas was 8.4 +/- 8.9. The mean ISS for those with vascular injuries was 17.9 +/- 12.6 (p < 0.001). Blunt trauma accounted for 90% of all nonvascular admissions. Penetrating trauma accounted for 10% of all nonvascular admissions. In the vascular trauma population, blunt trauma accounted for 56% and penetrating trauma accounted for 39%. Five percent of the vascular injuries identified were iatrogenic. Surgical intervention was required in 85.4% and 44.2% of the vascular and nonvascular trauma populations, respectively. The mortality rate for nonvascular admissions was 4.8% (65/1350). Those with vascular injuries had a mortality rate of 20.8% (10/48). For trauma patients requiring an operation, the mortality rate was 4.5% (27/597). For patients with vascular injuries who required an operation, the mortality rate was 25.7% (9/35) (p = 0.007).Vascular trauma represents a small percentage of all trauma admissions. These patients have a higher ISS on admission and more of them require surgical intervention. The operative and overall mortality rates are higher in patients with vascular injuries than in the general trauma population.

Journal Article↗
PubMed1992

Multivariate population-based analysis of the association of county trauma centers with per capita county trauma death rates.

UNLABELLED: The purpose of this study was to utilize a large population-based data base to determine the association of trauma centers with per capita county trauma death rates. METHODS: Per capita county trauma death rate, the dependent variable in the model, was obtained from a well-validated state Medical Examiner's data base. Over 200 county demographic, prehospital, and hospital trauma care resource variables were obtained from a variety of sources for multivariate modeling. Bivariate analysis identified candidate variables for multivariate modeling, excluding highly correlated independent variables to avoid problems of collinearity. Multivariate linear regression, logistic regression, and stepwise discriminant analysis were used to determine the relative association of the candidate variables with per capita county trauma death rates. RESULTS: Bivariate analysis identified multiple factors associated with per capita county trauma death rates. These included, among others: county rurality, percentage of unemployment, percentage nonwhite, 911 access, and ALS certified EMS. Per capita trauma death rates were significantly lower in counties with trauma centers compared with counties without trauma centers (4.0 +/- 0.5 and 5.0 +/- 1.1 deaths per 10,000 population, p = 0.0001, respectively). Multivariate analysis demonstrated that the presence of a trauma center in the county and ALS were the best medical system factors predicting decreased per capita county trauma death rates. CONCLUSIONS: This study is unique in utilizing a regional population-based data base of all trauma deaths in a large state to analyze the association of trauma centers and trauma death rates. Multivariate modeling controlling for other county variables demonstrated that the presence of a trauma center and Advanced Life Support training were the best predictors of per capita county trauma death rates. These findings are consistent with the hypothesis that trauma centers decrease trauma death rates.

Adult↗