OBJECTIVES: The public health implications of regional variation in incidence and outcome of severe traumatic injury remain to be analyzed. The objective of this study was to determine whether the incidence and outcome associated with severe traumatic injury differs across geographic regions of North America. METHODS: A prospective, observational study was conducted of the Resuscitation Outcomes Consortium of all patients in 9 North American sites (6 US and 3 Canadian) sustaining severe traumatic injury from April 1, 2006 to March 31, 2007 followed to hospital discharge. Eligible patients were assessed by organized emergency medical services, and had field-based physiologic criteria including systolic blood pressure <or=90 mm Hg, Glasgow Coma Scale score <or=12, respiratory rate <10 or >29 per minute, advanced airway procedure, or traumatic death in the field. Census data were used to determine rates adjusted for age and sex. The main outcome measures were incidence rate, mortality rate, case fatality rate, and survival to discharge for patients sustaining severe traumatic injury assessed by EMS. RESULTS: The total catchment population of 20.5 million yielded 7080 cases of severe traumatic injury. Median age was 36 years and 67% were male. The median incidence of EMS-assessed severe traumatic injury per 100,000 population across sites was 37.4 (interquartile range [IQR] = 24.6-69.6); survival ranged from 39.8% to 80.8%, with a median of 64.5% (IQR = 55.5-78.4). About 942 cases were pronounced dead at the scene and 5857 patients were transported to hospital; 4477 (63.2%) were discharged alive. The median incidence of severe trauma due to a blunt mechanism, transported to hospital, was 25.8 (IQR = 13.1-44.3); survival ranged from 52.6% to 87.3%, with a median of 78.0% (IQR = 68.4-83.5). The median incidence of severe penetrating trauma, transported to hospital, was 2.6 (IQR = 1.5-10.4); survival ranged from 37.5% to 84.7%, with a median of 67.5% (IQR = 54.1-75.9). All P values for differences across sites for incidence and survival were <0.001. CONCLUSIONS: In this study involving 9 geographic regions in North America, there were significant and important regional differences in severe traumatic injury, incidence, and outcome. These differences were sustained for patients with either isolated blunt or penetrating injury mechanisms.
OBJECTIVES: The public health implications of regional variation in incidence and outcome of severe traumatic injury remain to be analyzed. The objective of this study was to determine whether the incidence and outcome associated with severe traumatic injury differs across geographic regions of North America. METHODS: A prospective, observational study was conducted of the Resuscitation Outcomes Consortium of all patients in 9 North American sites (6 US and 3 Canadian) sustaining severe traumatic injury from April 1, 2006 to March 31, 2007 followed to hospital discharge. Eligible patients were assessed by organized emergency medical services, and had field-based physiologic criteria including systolic blood pressure <or=90 mm Hg, Glasgow Coma Scale score <or=12, respiratory rate <10 or >29 per minute, advanced airway procedure, or traumatic death in the field. Census data were used to determine rates adjusted for age and sex. The main outcome measures were incidence rate, mortality rate, case fatality rate, and survival to discharge for patients sustaining severe traumatic injury assessed by EMS. RESULTS: The total catchment population of 20.5 million yielded 7080 cases of severe traumatic injury. Median age was 36 years and 67% were male. The median incidence of EMS-assessed severe traumatic injury per 100,000 population across sites was 37.4 (interquartile range [IQR] = 24.6-69.6); survival ranged from 39.8% to 80.8%, with a median of 64.5% (IQR = 55.5-78.4). About 942 cases were pronounced dead at the scene and 5857 patients were transported to hospital; 4477 (63.2%) were discharged alive. The median incidence of severe trauma due to a blunt mechanism, transported to hospital, was 25.8 (IQR = 13.1-44.3); survival ranged from 52.6% to 87.3%, with a median of 78.0% (IQR = 68.4-83.5). The median incidence of severe penetrating trauma, transported to hospital, was 2.6 (IQR = 1.5-10.4); survival ranged from 37.5% to 84.7%, with a median of 67.5% (IQR = 54.1-75.9). All P values for differences across sites for incidence and survival were <0.001. CONCLUSIONS: In this study involving 9 geographic regions in North America, there were significant and important regional differences in severe traumatic injury, incidence, and outcome. These differences were sustained for patients with either isolated blunt or penetrating injury mechanisms.
Authors: Craig D Newgard; Robert H Schmicker; Jerris R Hedges; John P Trickett; Daniel P Davis; Eileen M Bulger; Tom P Aufderheide; Joseph P Minei; J Steven Hata; K Dean Gubler; Todd B Brown; Jean-Denis Yelle; Berit Bardarson; Graham Nichol Journal: Ann Emerg Med Date: 2009-09-23 Impact factor: 5.721
Authors: Gregory R Istre; Mary A McCoy; Katie N Womack; Linda Fanning; Laurette Dekat; Martha Stowe Journal: Am J Public Health Date: 2002-07 Impact factor: 9.308
Authors: Joshua B Brown; Matthew R Rosengart; Timothy R Billiar; Andrew B Peitzman; Jason L Sperry Journal: J Trauma Acute Care Surg Date: 2017-07 Impact factor: 3.313
Authors: Joshua B Brown; Matthew R Rosengart; Timothy R Billiar; Andrew B Peitzman; Jason L Sperry Journal: J Trauma Acute Care Surg Date: 2016-01 Impact factor: 3.313
Authors: Joshua B Brown; Mark L Gestring; Nicole A Stassen; Raquel M Forsythe; Timothy R Billiar; Andrew B Peitzman; Jason L Sperry Journal: Ann Surg Date: 2016-02 Impact factor: 12.969
Authors: Joseph P Minei; Timothy C Fabian; Danielle M Guffey; Craig D Newgard; Eileen M Bulger; Karen J Brasel; Jason L Sperry; Russell D MacDonald Journal: Ann Surg Date: 2014-09 Impact factor: 12.969
Authors: Elizabeth Y Killien; Brianna Mills; Monica S Vavilala; R Scott Watson; Grant E OʼKeefe; Frederick P Rivara Journal: J Trauma Acute Care Surg Date: 2019-05 Impact factor: 3.313
Authors: Craig D Newgard; Robert H Schmicker; George Sopko; Dug Andrusiek; Walter Bialkowski; Joseph P Minei; Karen Brasel; Eileen Bulger; Ross J Fleischman; Jeffrey D Kerby; Blair L Bigham; Craig R Warden Journal: Am J Public Health Date: 2011-04 Impact factor: 9.308
Authors: Shannon W Stephens; Carolyn Williams; Randal Gray; Jeffrey D Kerby; Henry E Wang; Patrick L Bosarge Journal: J Trauma Acute Care Surg Date: 2016-06 Impact factor: 3.313
Authors: Samuel A Tisherman; Robert H Schmicker; Karen J Brasel; Eileen M Bulger; Jeffrey D Kerby; Joseph P Minei; Judy L Powell; Donald A Reiff; Sandro B Rizoli; Martin A Schreiber Journal: Ann Surg Date: 2015-03 Impact factor: 12.969
Authors: Christopher C D Evans; Ashley Petersen; Eric N Meier; Jason E Buick; Martin Schreiber; Delores Kannas; Michael A Austin Journal: J Trauma Acute Care Surg Date: 2016-08 Impact factor: 3.313
Authors: Weston Andrew Smedley; John Killian; Kelly Lorraine Stone; Shannon W Stephens; Russell L Griffin; Daniel B Cox; Jeffrey D Kerby; Jan O Jansen Journal: J Surg Res Date: 2020-10-14 Impact factor: 2.192