The Right Treatment at the Right Time in the Right Place

A Population-based, Before-and-after Study of Outcomes Associated With Implementation of an All-inclusive Trauma System in a Large Canadian Province

Abstract

Objective: 

To evaluate the implementation of an all-inclusive philosophy of trauma care in a large Canadian province.

Background: 

Challenges to regionalized trauma care may occur where transport distances to level I trauma centers are substantial and few level I centers exist. In 2008, we modified our predominantly regionalized model to an all-inclusive one with the hopes of increasing the role of level III trauma centers.

Methods: 

We conducted a population-based, before-and-after study of patient admission and transfer practices and outcomes associated with implementation of an all-inclusive provincial trauma system using multivariable Poisson and linear regression and Cox proportional hazard models.

Results: 

In total, 21,772 major trauma patients were included. Implementation of the all-inclusive model of trauma care was associated with a decline in transfers directly to level I trauma centers [risk ratio (RR) = 0.91; 95% confidence interval (CI): 0.88–0.94; P < 0.001] and an increase in transfers from level III to level I centers (RR = 1.10; 95% CI: 1.00–1.21; P = 0.04). These changes in trauma care occurred in conjunction with a 12% reduction in the hazard of mortality (hazard ratio = 0.88; 95% CI: 0.84–0.98; P = 0.003) and a decrease in mean trauma patient hospital length of stay by 1 day (95% CI: 1.02–1.11; P = 0.02) after adjustment for differences in case mix.

Conclusions: 

In this study, introduction of an all-inclusive provincial trauma system was associated with an increased number of injured patients cared for in their local systems and improved trauma patient mortality and hospital length of stay.

In Brief

In this population-based, before-and-after study of 21,772 major trauma patients, the implementation of an all-inclusive model of provincial trauma care was associated with an increased proportion of injured patients cared for in their local systems, a significant 12% reduction in the hazard of mortality, and a decrease in trauma patient length of hospital stay.