Regional Trauma System Reduces Mortality and Changes Admission Rates: A Before and After Study

To evaluate the effect of the introduction of a regionalized trauma system. Trauma systems have proven to be efficacious in reducing mortality in trauma patients in the United States. To date, this was not proven for inclusive trauma systems outside the United States. The current study evaluates the effect of the introduction of an inclusive trauma system in the Netherlands in 1999. Retrospective pre- and post analyses of a trauma care system on hospital discharge data regarding trauma patients admitted to hospitals in the central region of The Netherlands. Patients treated during 1996 to 1998 (control group), before implementation of the inclusive trauma system were compared with patients treated during 2003 to 2005 (index group) after the trauma system was installed. Risk adjusted odds-ratios of death and admission to a trauma center were determined. A total of 33,201 patients were included in the control group and compared with 34,840 patients in the index group. After implementation of the trauma system, in-hospital mortality for all injured patients decreased from 2.6% to 2.3% (OR: 0.89 with 95% CI: 0.80-0.98). After adjustment for differences in gender, age, injury severity, comorbidity, injured body region, mechanism and intent of injury between both groups, the odds-ratio was 0.84 with 95% CI (0.76-0.94). Multitrauma patients were the subgroup admitted more frequently to a trauma center (OR: 1.19 with 95% CI: 1.01-1.39). Implementation of an inclusive trauma system in The Netherlands results in a more efficient triage system of trauma patients among hospitals and is associated with a substantial and statistically significant risk reduction (16%) of death.