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Trauma care regionalization: a process-outcome evaluation
J S Sampalis1, R Denis, A Lavoie
1Department of Surgery, McGill University, Montreal General Hospital Trauma Program, Québec, Canada.
The Journal of Trauma
|April 27, 1999
Summary
Regionalizing trauma care significantly reduced major trauma patient mortality by 18% through improved tertiary center care and reduced prehospital times. This demonstrates the effectiveness of integrated trauma systems in saving lives.
Area of Science:
- Trauma Care Systems
- Public Health Policy
- Emergency Medicine
Background:
- Regionalization of trauma care initiated in 1993 with four tertiary centers.
- Expanded network includes 33 secondary, 30 primary, and 32 stabilization centers.
- Emergency medical personnel training enhanced prehospital assessment and triage.
Purpose of the Study:
- Evaluate the impact of trauma care regionalization on major trauma patient mortality.
- Assess the effectiveness of integrated trauma care networks.
Main Methods:
- Prospective study using the Quebec Trauma Registry (1993-1998).
- Included major trauma patients (death, ISS > 12, etc.).
- Defined four phases of regionalization (pre-regionalization to advanced).
Main Results:
- Mortality decreased from 52% (phase 0) to 18% (phase III).
- Significant decline in mortality for ISS 12-49; prehospital time reduced from 62 to 44 minutes.
- Tertiary centers showed consistently lower mortality; direct transport to tertiary centers improved outcomes.
Conclusions:
- Regionalized trauma care systems demonstrably reduce mortality.
- Tertiary trauma centers and reduced prehospital times are critical for efficient trauma care.