Progress in the development of trauma systems in the United States. Results of a national survey
G. J. Bazzoli, K. J. Madura, G. F. Cooper, E. J. MacKenzie and R. V. Maier
Hospital Research and Educational Trust, Chicago, IL 60606.
OBJECTIVE--To examine the status of trauma system development and key
structural and operational characteristics of these systems. DESIGN AND
SETTING--National survey of trauma systems with enabling state statute,
regulation, or executive orders and for which designated trauma centers
were present. PARTICIPANTS--Trauma system administrators and directors of
37 state and regional organizations that had legal authority to administer
trauma systems, which represented a response rate of 90.2%. MAIN OUTCOME
MEASURES--Trauma system components that had been implemented or were under
development. RESULTS--From 1988 to 1993, the number of states meeting one
set of criteria for a complete trauma system criteria increased from two to
five. The most common deficiency in establishing trauma systems was failure
to limit the number of designated trauma centers based on community need.
Although most existing trauma systems have developed formal processes for
designating trauma centers, prehospital triage protocols to allow hospital
bypass, and centralized trauma registries, several systems lack
standardized policies for interhospital transfer and systemwide evaluation.
CONCLUSION--State and regional organizations have accomplished a great deal
but still have substantial work ahead in developing comprehensive trauma
systems. Research is needed to better understand the relationship between
trauma volume and outcomes of care as well as the impact of trauma system
structure and operational characteristics on care delivery. Improved
measures of patient outcome are also needed so that effective system
evaluation can take place.
