Brice L Batomen Kuimi1, Lynne Moore2, Brahim Cissé2, Mathieu Gagné3, André Lavoie2, Gilles Bourgeois4, Jean Lapointe4. 1. Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada; Institut National de Santé Publique du Québec, QC, Canada. Electronic address: brice-lionel.batomen-kuimi.1@ulaval.ca. 2. Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada. 3. Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada; Institut National de Santé Publique du Québec, QC, Canada. 4. Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada.
Abstract
BACKGROUND: Few data are available on population-based access to specialised trauma care and its influence on patient outcomes in an integrated trauma system. We aimed to evaluate the influence of access to an integrate trauma system on in-hospital mortality and length of stay (LOS). METHODS: All adults admitted to acute care hospitals for major trauma [International Classification of Diseases Injury Severity Score (ICISS<0.85)] in a Canadian province with an integrated trauma system between 2006 and 2011 were included using an administrative hospital discharge database. The influence of access to an integrated trauma system on in-hospital mortality and LOS was assessed globally and for critically injured patients (ICISS<0.75), according to the type of injury [traumatic brain injury (TBI), abdominal/thoracic, spine, orthopaedic] using logistic and linear multivariable regression models. RESULTS: We identified 22,749 injury admissions. In-hospital mortality was 7% and median LOS was 9 days for all injuries. Overall, 92% of patients were treated within the trauma system. Globally, patients who did not have access had similar mortality and LOS compared to patients who had access. However, we observed a 62% reduction in mortality for critical abdominal/thoracic injuries (odds ratio=0.38; 95% CI, 0.16-0.92) and an 8% increase in LOS for TBI patients (geometric mean ratio=1.08; 95% CI, 1.02-1.14) treated within the trauma system. CONCLUSIONS: Results provides evidence that in a health system with an integrated mature trauma system, access to specialised trauma care is high and the small proportion of patients treated outside the system, have similar mortality and LOS compared to patients treated within the system. This study suggests that the Québec trauma system performs well in its mandate to offer appropriate treatment to victims of injury that require specialised care.
BACKGROUND: Few data are available on population-based access to specialised trauma care and its influence on patient outcomes in an integrated trauma system. We aimed to evaluate the influence of access to an integrate trauma system on in-hospital mortality and length of stay (LOS). METHODS: All adults admitted to acute care hospitals for major trauma [International Classification of Diseases Injury Severity Score (ICISS<0.85)] in a Canadian province with an integrated trauma system between 2006 and 2011 were included using an administrative hospital discharge database. The influence of access to an integrated trauma system on in-hospital mortality and LOS was assessed globally and for critically injured patients (ICISS<0.75), according to the type of injury [traumatic brain injury (TBI), abdominal/thoracic, spine, orthopaedic] using logistic and linear multivariable regression models. RESULTS: We identified 22,749 injury admissions. In-hospital mortality was 7% and median LOS was 9 days for all injuries. Overall, 92% of patients were treated within the trauma system. Globally, patients who did not have access had similar mortality and LOS compared to patients who had access. However, we observed a 62% reduction in mortality for critical abdominal/thoracic injuries (odds ratio=0.38; 95% CI, 0.16-0.92) and an 8% increase in LOS for TBIpatients (geometric mean ratio=1.08; 95% CI, 1.02-1.14) treated within the trauma system. CONCLUSIONS: Results provides evidence that in a health system with an integrated mature trauma system, access to specialised trauma care is high and the small proportion of patients treated outside the system, have similar mortality and LOS compared to patients treated within the system. This study suggests that the Québec trauma system performs well in its mandate to offer appropriate treatment to victims of injury that require specialised care.
Authors: Roos Johanna Maria Havermans; Felix Johannes Clouth; Koen Willem Wouter Lansink; Jeroen Kornelis Vermunt; Mariska Adriana Cornelia de Jongh; Leonie de Munter Journal: Eur J Trauma Emerg Surg Date: 2021-11-15 Impact factor: 3.693
Authors: Roos Johanna Maria Havermans; Mariska Adriana Cornelia de Jongh; Leonie de Munter; Koen Willem Wouter Lansink Journal: Scand J Trauma Resusc Emerg Med Date: 2020-04-20 Impact factor: 2.953