Effect of trauma system maturation on mortality rates in patients with blunt injuries in the Finger Lakes Region of New York State.

BACKGROUND: New York State instituted a statewide trauma system beginning in 1990. By 1993, that system included uniform emergency medical system triage guidelines, designated trauma centers, transfer agreements between trauma centers and noncenters, and a trauma registry containing data on seriously injured patients in each region and the state as a whole. We reviewed the first 4 years of registry data for the Finger Lakes Region to determine what effects the institution of a trauma system has had on the outcome of trauma care in this region.
DESIGN: Retrospective review of a regional trauma database.
METHODS: All qualifying injured patients in the region were entered into the registry beginning in 1993. Data from 1993 through 1996 for patients with blunt injuries were analyzed by both Trauma and Injury Severity Score (TRISS) methodology and logistic regression analysis. For comparison, two time periods were defined: 1993-1994 and 1995-1996. Outcomes for the two time periods were stratified by Revised Trauma Score and the presence or absence of head and/or cervical spine injury, and then compared by hospital type (regional trauma center, area trauma center, and noncenters).
RESULTS: In the later time period, there was a statistically significant decrease in the region-wide mortality rate. This was associated with a marked improvement in performance of the noncenters and with an increase in the proportion of patients who received definitive care at a trauma center.
CONCLUSIONS: Improved outcomes for patients with blunt trauma can occur early in the implementation of a trauma system. This improvement may be attributable in part to changes in field triage and early transport to trauma centers.