You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Improved Functional Outcomes for Major Trauma Patients in a Regionalized, Inclusive Trauma System

Gabbe, Belinda J. BPhysio (Hons); Biostat, Grad Dip MAppSc, PhD*; Simpson, Pam M. BSc (Hons)*; Sutherland, Ann M. RN, RM; Dip, Grad Occ Environ Health*,†; Wolfe, Rory BSc, PhD*; Fitzgerald, Mark C. MBBS, FACEM, MRACMA‡,§; Judson, Rodney MBBS, FRACS, FRCS, FACS; Cameron, Peter A. MBBS, MD, FACEM*,†

Annals of Surgery:
doi: 10.1097/SLA.0b013e31824c4b91

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.

In Brief

This population-based cohort study found that despite an annual decline in mortality, risk-adjusted functional outcomes improved over time, and cases managed at level-1 trauma centers demonstrated better outcomes. There was no evidence of a shift in burden from fatal to nonfatal injury through patients surviving to live with significant disability.

Author Information

*Department of Epidemiology and Preventive Medicine, Monash University

Emergency and Trauma Centre, The Alfred Hospital

Trauma Service, The Alfred Hospital

§Ambulance Victoria

Trauma Service, Royal Melbourne Hospital, Melbourne, Australia.

Reprints: Belinda J. Gabbe, BPhysio (Hons), Grad Dip Biostat, MAppSc, PhD, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne Victoria 3004, Australia. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.