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Effect of Trauma Systems on Motor Vehicle Occupant Mortality: A Comparison Between States With and Without a Formal System

Shafi, Shahid MD, MPH; Nathens, Avery B. MD, MPH, PhD; Elliott, Alan C. MAS, MBA; Gentilello, Larry MD

The Journal of Trauma: Injury, Infection, and Critical Care: December 2006 - Volume 61 - Issue 6 - p 1374-1379
doi: 10.1097/01.ta.0000246698.07125.c0
Original Articles

Background: Population-based studies using a “before-and-after” methodology report a reduction in motor vehicle collision mortality with implementation of statewide trauma systems (TS). However, concurrent improvements in roads, cars, restraint systems, and changes in rates of drunk driving, socioeconomics, speed limits, urban or rural mix, and traffic density may also be responsible for the progressive reduction in mortality rates. We hypothesized that a statewide TS independently reduces injury mortality, irrespective of other factors.

Methods: Data were acquired from several federal agencies including the Centers for Disease Control (CDC), The National Highway Traffic Safety Administration (NHTSA), the United States Department of Transportation (DOT), and the United States Census Bureau. Age-adjusted motor vehicle occupant (MVO) death rates per 100,000 population were compared in states with and without a TS. Negative binomial regression was used to calculate risk ratios (RR) comparing mortality in TS and non-TS states after adjusting for effects of gender, race, primary seat belt laws, seat belt use, alcohol use, miles traveled, population density, per capita income, types of registered vehicles, and rural or urban mix.

Results: The number of states with a TS increased from 7 in 1981 to 36 in 2002. Concurrently, nationwide MVO death rates decreased by 2.6 per 100,000 (95% confidence interval 1.2–3.9; p < 0.001). Income, primary seat belt laws, restraint use, speed limits, and rural or urban population distribution (p < 0.05 for all), were independent predictors of MVO mortality, but not presence of a TS (RR 0.95, 95% confidence interval 0.73–1.23; p = 0.68).

Conclusions: MVO death rates have declined over time, and are lower in TS states. However, the cause is multi-factorial, and cannot be attributed solely to presence of TS. Further studies are needed to identify beneficial components of a statewide trauma system.

From the Department of Surgery, Division of Burn, Trauma and Surgical Critical Care (S.S., L.G.) and Center for Biostatistics and Clinical Sciences (A.C.E.), University of Texas Southwestern Medical School, Dallas, Texas; and Department of Surgery, University of Washington, Seattle, Washington (A.B.N.).

Submitted for publication November 16, 2005.

Accepted for publication July 14, 2006.

Presented as a poster at the 64th Annual Meeting of the American Association of the Surgery of Trauma, September 22–24, 2005, Atlanta, Georgia.

Address for Reprints: Shahid Shafi, MD, MPH, Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 9158, Dallas, TX 75390-9158; email:

© 2006 Lippincott Williams & Wilkins, Inc.