Cost and effectiveness issues in care of injured patients.

Injury remains the leading public health problem in the United States in terms of cost and years of life lost. It is the number 1 cause of death and disability from birth to 44 years old, which is the most economically productive segment of our population. In the current environment of rapid-pace health care system reform at the state and national levels, trauma care systems have evolved at the forefront; regionalization, continuous quality improvement systems, designation/accreditation systems, registry databases, and cost-effectiveness evaluations are being implemented in many states. In most states, these systems remain immature, but the critical framework is in place. This article attempts to present the current state of cost of injury and effectiveness data, the status of trauma registries, and the evolution of functional outcome research in trauma care.