Evaluation of a mature trauma system

Area of Science:

• Trauma system evaluation
• Health services research
• Public health policy

Background:

• Effective trauma systems aim to improve patient survival and provide cost-effective care.
• Assessing the survival advantage, cost-effectiveness, and accessibility of trauma centers is crucial.
• This study evaluates the Florida state trauma system.

Purpose of the Study:

• To determine if treatment at a trauma center (TC) improves survival compared to a non-trauma center (NTC).
• To assess the cost-effectiveness of the trauma system.
• To evaluate the equity of access to trauma care within the state.

Main Methods:

• Utilized the 2003 Florida discharge database for patients with ICD9 codes 800-959.
• Calculated survival risk ratios (SRR) and Instrumental Variables Confidence Intervals (ICISS) using historical data.
• Analyzed mortality rates, cost-benefit ratios, and geographic accessibility to trauma centers.

Main Results:

• Treatment at a TC was associated with an 18% reduction in patient mortality.
• The cost per life saved was calculated at $34,887, with a favorable cost/life year saved ratio.
• Currently, 95% of the population has access within 85 minutes, but only 38% of patients are triaged to a TC; adding 3 TCs would improve this to 65%.

Conclusions:

• Triage to a Florida TC significantly decreases the risk of death.
• The trauma system demonstrates favorable cost-effectiveness compared to other health expenditures.
• Optimizing access requires improved deployment of trauma centers, and this methodology can evaluate mature systems.