The right treatment at the right time in the right place: a population-based, before-and-after study of outcomes associated with implementation of an all-inclusive trauma system in a large Canadian province

Jessica L Mckee, Derek J Roberts, Mary H van Wijngaarden-Stephens, Christine Vis, He Gao, Kathy L Belton, Don Voaklander, Chad G Ball, Ioana Bratu, Geoffrey C Ibbotson, Kevin Martin, Paul Engels, Damian Paton-Gay, Paul Parks, Lyle Thomas, Jonathan Guilfoyle, John B Kortbeek, Andrew W Kirkpatrick
Annals of Surgery 2015, 261 (3): 558-64

OBJECTIVE: To evaluate the implementation of an all-inclusive philosophy of trauma care in a large Canadian province.

BACKGROUND: Challenges to regionalized trauma care may occur where transport distances to level I trauma centers are substantial and few level I centers exist. In 2008, we modified our predominantly regionalized model to an all-inclusive one with the hopes of increasing the role of level III trauma centers.

METHODS: We conducted a population-based, before-and-after study of patient admission and transfer practices and outcomes associated with implementation of an all-inclusive provincial trauma system using multivariable Poisson and linear regression and Cox proportional hazard models.

RESULTS: In total, 21,772 major trauma patients were included. Implementation of the all-inclusive model of trauma care was associated with a decline in transfers directly to level I trauma centers [risk ratio (RR) = 0.91; 95% confidence interval (CI): 0.88-0.94; P < 0.001] and an increase in transfers from level III to level I centers (RR = 1.10; 95% CI: 1.00-1.21; P = 0.04). These changes in trauma care occurred in conjunction with a 12% reduction in the hazard of mortality (hazard ratio = 0.88; 95% CI: 0.84-0.98; P = 0.003) and a decrease in mean trauma patient hospital length of stay by 1 day (95% CI: 1.02-1.11; P = 0.02) after adjustment for differences in case mix.

CONCLUSIONS: In this study, introduction of an all-inclusive provincial trauma system was associated with an increased number of injured patients cared for in their local systems and improved trauma patient mortality and hospital length of stay.

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