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J Trauma. 2006 Aug;61(2):261-6; discussion 266-7.

Assessing effectiveness of a mature trauma system: Association of trauma center presence with lower injury mortality rate.

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Department of Emergency Medicine, University of Florida, Gainesville, Florida 32608, USA.



To determine effectiveness of trauma center care in a mature trauma system by comparing motor vehicle crash (MVC) death rates in counties with a trauma center (TC) to those without a trauma center (NTC).


State data for MVCs occurring in 2003 were analyzed. Fatalities from crashes in counties with a TC were compared with NTC counties. The primary outcome was case-fatality rate and the secondary outcome was crash-fatality rate. Data from 67 Florida counties and 20 TCs were assessed. Covariates such as age, speed, alcohol use, prehospital resources, and rural/urban location were adjusted for in the analysis.


The statewide incidence of fatality from MVC in 2003 was 18.6 per 100,000. The overall state case-fatality rate was 2.8% (95% CI = 2.4-3.3). There were 13 TC counties with a mean fatality rate of 17.7 per 100,000 (95% CI = 14.5-20.9) and 54 NTC counties with a mean fatality rate 33.4 per 100,000 (95% CI = 28.8-38.0; p < 0.001). The case-fatality rate was 1.4% (95% CI = 1.1-1.7) in TC counties and 3.2% (95% CI = 2.7-3.7) in NTC counties (p < 0.001). Moreover, crash-fatality rate in TC counties and NTC counties was 1.4% (95% CI = 1.0-1.8) versus 3.3% (95% CI = 2.8-3.7) respectively (p < 0.001).


TC counties had significantly lower MVC death rates than NTC counties. This association was independent of age, alcohol use, speed, rural/urban location, and prehospital resources.

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