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The Effect of an Organized Trauma System on Mortality in Major Trauma Involving Serious Head Injury: A Comparison of the United Kingdom and Victoria, Australia

Gabbe, Belinda J. PhD, MAppSc; Biostat, Grad Dip*,†; Lecky, Fiona E. PhD‡,§; Bouamra, Omar PhD; Woodford, Maralyn BSc; Jenks, Tom BA(Hons), MSc; Coats, Timothy J. MBBS, MD, FRCS, FFAEM‡,¶; Cameron, Peter A. MBBS, MD, FACEM*,†,**

Annals of Surgery:
doi: 10.1097/SLA.0b013e3181f6685b
Original Study
Abstract

Objective: To compare outcomes following major trauma involving serious head injury managed in an inclusive trauma system (Victoria, Australia) and a setting where rationalization of trauma services is absent (England/Wales).

Background: The introduction of regionalized trauma systems has the potential to reduce preventable deaths, but their uptake has been slow around the world. Improved understanding of the benefits and limitations of different systems of trauma care requires comparison across systems.

Methods: Mortality outcomes following major trauma involving serious head injury managed in the 2 settings were compared using multivariate logistic regression. Data pertaining to the period July 2001 to June 2006 (inclusive) were extracted from the Trauma Audit and Research Network (TARN) in the United Kingdom and the Victorian State Trauma Registry (VSTR) in Australia.

Results: A total of 4064 (VSTR) and 6024 (TARN) cases were provided for analysis. The odds of death for TARN cases were significantly higher than those for VSTR cases [odds ratio = 2.15, 95% confidence interval = 1.95–2.37]. After adjusting for age, gender, cause of injury, head injury severity, Glasgow Coma Scale score, and Injury Severity Score, TARN cases remained at elevated odds of death (3.22; 95% confidence interval = 2.84–3.65) compared with VSTR cases.

Conclusions: Management of the severely injured patient with an associated head injury in England and Wales, where an organized trauma system is absent, was associated with increased risk-adjusted mortality compared with management of these patients in the inclusive trauma system of Victoria, Australia. This study provides further evidence to support efforts to implement such systems.

In Brief

Worldwide, implementation of regionalized trauma systems has been low. Head injured major trauma patients managed in England and Wales, where an organized trauma system is absent, demonstrated increased risk-adjusted mortality compared to patients managed by an inclusive trauma system in Australia, providing further evidence of the benefit of trauma systems.

Author Information

*Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia

National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia

The Trauma Audit and Research Network, University of Manchester, Clinical Services Building, Hope Hospital, Salford, United Kingdom

§Department of Emergency Medicine, Hope Hospital, Salford, United Kingdom

Accident and Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester, United Kingdom

**Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.

Reprints: Belinda Gabbe, PhD, MAppSc, Grad Dip Biostat, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne Victoria Australia 3004. E-mail: belinda.gabbe@med.monash.edu.au.

The VSTR is a Department of Human Services (Victoria) and TAC Health Research–funded and -approved initiative. Dr Belinda Gabbe and Prof Peter Cameron were supported by a Career Development Award, and a practitioner fellowship, from the National Health and Medical Research Council of Australia, respectively.

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© 2011 Lippincott Williams & Wilkins, Inc.