Lynne Moore1, David Evans, Sayed M Hameed, Natalie L Yanchar, Henry T Stelfox, Richard Simons, John Kortbeek, Gilles Bourgeois, Julien Clément, François Lauzier, Avery Nathens, Alexis F Turgeon. 1. *Department of Social and Preventative Medicine, Université Laval, Québec, Canada †Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada ‡Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada §Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ¶Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), Institute for Public Health, University of Calgary, Calgary, Alberta, Canada ||Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta, Canada **Institut national d'excellence en santé et en services sociaux (INESSS), Québec, Canada ††Department of Surgery, Université Laval, Québec, Canada ‡‡Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Canada §§Division of General Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: To measure the variation in trauma center mortality across Canadian trauma systems, assess the contribution of traumatic brain injury and thoracoabdominal injury to observed variations, and evaluate whether the presence of recommended trauma system components is associated with mortality. SUMMARY BACKGROUND DATA: Injuries represent one of the leading causes of mortality, disability, and health care costs worldwide. Trauma systems have improved injury outcomes, but the impact of trauma system configuration on mortality is unknown. METHODS: We conducted a retrospective cohort study of adults admitted for major injury to trauma centers across Canada (2006-2012). Multilevel logistic regression was used to estimate risk-adjusted hospital mortality and assess the impact of 13 recommended trauma system components. RESULTS: Of 78,807 patients, 8382 (10.6%) died in hospital including 6516 (78%) after severe traumatic brain injury and 749 (9%) after severe thoracoabdominal injury. Risk-adjusted mortality varied from 7.0% to 14.2% across provinces (P < 0.0001); 11.1% to 26.0% for severe traumatic brain injury (P < 0.0001), and 4.7% to 5.9% for thoracoabdominal injury (P = 0.2). Mortality decreased with increasing number of recommended trauma system elements; adjusted odds ratio = 0.93 (0.87-0.99). CONCLUSIONS: We observed significant variation in trauma center mortality across Canadian provinces, specifically for severe traumatic brain injury. Provinces with more recommended trauma system components had better patient survival. Results suggest that trauma system configuration may be an important determinant of injury mortality. A better understanding of which system processes drive optimal outcomes is required to reduce the burden of injury worldwide.
OBJECTIVE: To measure the variation in trauma center mortality across Canadian trauma systems, assess the contribution of traumatic brain injury and thoracoabdominal injury to observed variations, and evaluate whether the presence of recommended trauma system components is associated with mortality. SUMMARY BACKGROUND DATA: Injuries represent one of the leading causes of mortality, disability, and health care costs worldwide. Trauma systems have improved injury outcomes, but the impact of trauma system configuration on mortality is unknown. METHODS: We conducted a retrospective cohort study of adults admitted for major injury to trauma centers across Canada (2006-2012). Multilevel logistic regression was used to estimate risk-adjusted hospital mortality and assess the impact of 13 recommended trauma system components. RESULTS: Of 78,807 patients, 8382 (10.6%) died in hospital including 6516 (78%) after severe traumatic brain injury and 749 (9%) after severe thoracoabdominal injury. Risk-adjusted mortality varied from 7.0% to 14.2% across provinces (P < 0.0001); 11.1% to 26.0% for severe traumatic brain injury (P < 0.0001), and 4.7% to 5.9% for thoracoabdominal injury (P = 0.2). Mortality decreased with increasing number of recommended trauma system elements; adjusted odds ratio = 0.93 (0.87-0.99). CONCLUSIONS: We observed significant variation in trauma center mortality across Canadian provinces, specifically for severe traumatic brain injury. Provinces with more recommended trauma system components had better patient survival. Results suggest that trauma system configuration may be an important determinant of injury mortality. A better understanding of which system processes drive optimal outcomes is required to reduce the burden of injury worldwide.
Authors: Lynne Moore; Howard Champion; Pier-Alexandre Tardif; Brice-Lionel Kuimi; Gerard O'Reilly; Ari Leppaniemi; Peter Cameron; Cameron S Palmer; Fikri M Abu-Zidan; Belinda Gabbe; Christine Gaarder; Natalie Yanchar; Henry Thomas Stelfox; Raul Coimbra; John Kortbeek; Vanessa K Noonan; Amy Gunning; Malcolm Gordon; Monty Khajanchi; Teegwendé V Porgo; Alexis F Turgeon; Luke Leenen Journal: World J Surg Date: 2018-05 Impact factor: 3.352
Authors: Lynne Moore; David Evans; Natalie L Yanchar; Jaimini Thakore; Henry Thomas Stelfox; Morad Hameed; Richard Simons; John Kortbeek; Julien Clément; François Lauzier; Alexis F Turgeon Journal: Can J Surg Date: 2017-12 Impact factor: 2.089
Authors: Lynne Moore; Khadidja Malloum Boukar; Pier-Alexandre Tardif; Henry T Stelfox; Howard Champion; Peter Cameron; Belinda Gabbe; Natalie Yanchar; John Kortbeek; François Lauzier; France Légaré; Patrick Archambault; Alexis F Turgeon Journal: BMJ Open Date: 2017-07-12 Impact factor: 2.692
Authors: Jilske A Huijben; Victor Volovici; Maryse C Cnossen; Iain K Haitsma; Nino Stocchetti; Andrew I R Maas; David K Menon; Ari Ercole; Giuseppe Citerio; David Nelson; Suzanne Polinder; Ewout W Steyerberg; Hester F Lingsma; Mathieu van der Jagt Journal: Crit Care Date: 2018-04-13 Impact factor: 9.097
Authors: Kate Curtis; Rebecca Mitchell; Amy McCarthy; Kellie Wilson; Connie Van; Belinda Kennedy; Gary Tall; Andrew Holland; Kim Foster; Stuart Dickinson; Henry T Stelfox Journal: Scand J Trauma Resusc Emerg Med Date: 2017-02-28 Impact factor: 2.953
Authors: Blanchard Conombo; Jason Robert Guertin; Pier-Alexandre Tardif; Imen Farhat; Thomas Moore; Samy Bouderba; Kahina Soltana; Patrick Archambault; Simon Berthelot; François Lauzier; Alexis F Turgeon; Henry Thomas Stelfox; Michaël Chasse; Jeffrey Hoch; Lynne Moore Journal: BMJ Open Date: 2020-07-14 Impact factor: 2.692