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Trauma System Impact on Admission Site: A Comparison of Two States

Mann, N. Clay PhD, MS; Hedges, Jerris R. MD, MS; Sandoval, Ronald PhD; Worrall, William MA; Zechnich, Andrew D. MD, MPH; Jurkovich, Gregory J. MD; Mullins, Richard J. MD

Journal of Trauma and Acute Care Surgery: April 1999 - Volume 46 - Issue 4 - p 631-637
Article: Presented At The 58Th Annual Meeting Of The American Association For The Surgery Of Trauma Meeting Jointly With The Trauma Association Of Canada, September 24-26, 1998, Baltimore, Maryland

Objective To introduce a measure assessing statewide hospital admission patterns for trauma and evaluate its utility in identifying significant admission redistributions in neighboring states as a function of trauma system implementation.

Methods A retrospective claims database analysis was performed of hospitalized trauma patients in Washington and Oregon. The site of hospitalization and diagnostic information were used to determine an admission rate difference for each hospital: the rate of index patient admissions minus the rate of non-index patient admissions. Mean admission rate differences for Level II and III versus other hospitals in each state were compared as a function of time.

Results A bias in favor of admitting more serious injuries to Level II and III hospitals was seen with trauma system implementation in both states, but it was more pronounced in the Oregon trauma system.

Conclusion Assessment of admission rate differences is a helpful method of characterizing the evolution of statewide trauma systems.

From the Departments of Emergency Medicine (N.C.M., J.R.H., A.D.Z.) and Surgery (R.S., W.W., R.J.M.), Oregon Health Sciences University, School of Medicine, Portland, Oregon; and the Department of Surgery (G.J.J.), University of Washington, School of Medicine, Seattle, Washington.

Presented at the Seventh International Conference on Emergency Medicine, March 25-29, 1998, Vancouver, British Columbia, Canada.

This study was supported by grant R49/CCR-006283 from the U.S. Public Health Service, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

The authors are solely responsible for the content of the article, and the opinions do not necessarily represent the views of the Centers for Disease Control and Prevention.

Address for reprints: N. Clay Mann, PhD, MS, Department of Emergency Medicine, CR-114, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098; e-mail:

© 1999 Lippincott Williams & Wilkins, Inc.