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Mortality in Canadian Trauma Systems: A Multicenter Cohort Study.
Lynne Moore1, David Evans, Sayed M Hameed
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.
Trauma system configuration significantly impacts patient survival. Provinces with more recommended trauma system components showed lower mortality rates, particularly for severe traumatic brain injury, highlighting the importance of system design in reducing injury deaths.
Area of Science:
- Trauma care systems research
- Public health policy
- Injury epidemiology
Background:
- Injuries are a major global cause of death, disability, and healthcare costs.
- Trauma systems aim to improve outcomes, but their configuration's impact on mortality remains unclear.
Purpose of the Study:
- Measure trauma center mortality variation in Canada.
- Assess traumatic brain injury and thoracoabdominal injury contributions to this variation.
- Evaluate the association between recommended trauma system components and mortality.
Main Methods:
- Retrospective cohort study of adults with major injuries admitted to Canadian trauma centers (2006-2012).
- Multilevel logistic regression analysis.
- Assessment of 13 recommended trauma system components.
Main Results:
- Significant variation in risk-adjusted mortality (7.0%-14.2%) across provinces.
- Substantial variation for severe traumatic brain injury (11.1%-26.0%) but not thoracoabdominal injury (4.7%-5.9%).
- Increased number of trauma system components correlated with decreased mortality (aOR=0.93).
Conclusions:
- Trauma center mortality varies significantly across Canadian provinces, especially for severe traumatic brain injury.
- Provinces with more recommended trauma system components demonstrated improved patient survival.
- Trauma system configuration is a critical determinant of injury mortality, necessitating further research into optimal system processes.
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