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Ann Surg. 2012 Jun;255(6):1009-15. doi: 10.1097/SLA.0b013e31824c4b91.

Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system.

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1
Department of Epidemiology and Preventive Medicine, Monash University, Australia. belinda.gabbe@monash.edu

Abstract

OBJECTIVE:

To describe outcomes of major trauma survivors managed in an organized trauma system, including the association between levels of care and outcomes over time.

BACKGROUND:

Trauma care systems aim to reduce deaths and disability. Studies have found that regionalization of trauma care reduces mortality but the impact on quality of survival is unknown. Evaluation of a trauma system should include mortality and morbidity.

METHODS:

Predictors of 12-month functional (Glasgow Outcome Scale-Extended) outcomes after blunt major trauma (Injury Severity Score >15) in an organized trauma system were explored using ordered logistic regression for the period October 2006 to June 2009. Data from the population-based Victorian State Trauma Registry were used.

RESULTS:

There were 4986 patients older than 18 years. In-hospital mortality decreased from 11.9% in 2006-2007 to 9.9% in 2008-2009. The follow-up rate at 12 months was 86% (n = 3824). Eighty percent reported functional limitations. Odds of better functional outcome increased in the 2007-2008 [adjusted odds ratio (AOR): 1.22; 95% CI: 1.05, 1.41] and 2008-2009 (AOR: 1.16; 95% CI: 1.01, 1.34) years compared with 2006-2007. Cases managed at major trauma services (MTS) achieved better functional outcome (AOR: 1.22; 95% CI: 1.03, 1.45). Female gender, older age, and lower levels of education demonstrated lower adjusted odds of better outcome.

CONCLUSIONS:

Despite an annual decline in mortality, risk-adjusted functional outcomes improved over time, and cases managed at MTS (level-1 trauma centers) demonstrated better functional outcomes. The findings provide early evidence that this inclusive, regionalized trauma system is achieving its aims.

PMID:
22584628
DOI:
10.1097/SLA.0b013e31824c4b91
[Indexed for MEDLINE]
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