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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*,†

doi: 10.1097/SLA.0b013e31824c4b91
Feature

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.

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.

*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: belinda.gabbe@monash.edu.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.