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Richard J. Mullins, MD; Judith Veum-Stone, MS; Mark Helfand, MD; Melanie Zimmer-Gembeck, MS; Jerris R. Hedges, MD; Patricia A. Southard, RN, JD; Donald D. Trunkey, MD

JAMA. 1994;271(24):1919-1924.

Abstract
Objective.
—To determine if risk of death for hospitalized injured patients changes when an urban trauma system is implemented.

Design.
—An analysis of the risk of death in hospitalized injured patients in 1984 and 1985 (pretrauma system), 1986 and 1987 (early trauma system), and 1990 and 1991 (established trauma system) using hospital discharge abstract data.

Setting.
—A total of 18 acute care hospitals in the four-county area encompassing Portland, Ore.

Patients.
—A cohort of 70 350 hospitalized patients with at least one discharge diagnosis indicating injury.

Main Outcome Measure.
—Death during hospitalization.

Results.
—After the trauma system was established, 77% of patients in the region with an Injury Severity Score (ISS) of 16 or greater were admitted to level I trauma centers. More than 72% of patients with an ISS less than 16 were hospitalized in nontrauma centers. Risk of death for injured patients hospitalized at level I trauma centers declined after the trauma system was established (odds ratio, 0.65; 95% confidence interval, 0.51 to 0.81). Patients who died in trauma centers after institution of the trauma system were younger and had more severe injuries, and the majority died within 1 day of admission, whereas patients who died in nontrauma centers died a median of 5 days after admission.

Conclusion.
—Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.

(JAMA. 1994;271:1919-1924)

Author Affiliations
From the Division of General Surgery, Department of Surgery (Drs Mullins and Trunkey), the Biomedical Information Communication Center (Mss Veum-Stone and Zimmer-Gembeck and Dr Helfand), the Department of Emergency Medicine (Dr Hedges), and the Trauma Program (Ms Southard), Oregon Health Sciences University, Portland.

Footnotes
The authors are solely responsible for the content of the article, and the opinions do not necessarily represent the views of the Centers for Disease Control and Prevention.

Reprint requests to Department of Surgery L223A, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97201-3098 (Dr Mullins).

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