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Avery B. Nathens, MD, PhD; Gregory J. Jurkovich, MD; Peter Cummings, MD, MPH; Frederick P. Rivara, MD, MPH; Ronald V. Maier, MD

JAMA. 2000;283:1990-1994.

Context  Despite calls for wider national implementation of an integrated approach to trauma care, the effectiveness of this approach at a regional or state level remains unproven.

Objective  To determine whether implementation of an organized system of trauma care reduces mortality due to motor vehicle crashes.

Design  Cross-sectional time-series analysis of crash mortality data collected for 1979 through 1995 from the Fatality Analysis Reporting System.

Setting  All 50 US states and the District of Columbia.

Subjects  All front-seat passenger vehicle occupants aged 15 to 74 years.

Main Outcome Measures  Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimates are based on within-state comparisons adjusted for national trends in crash mortality.

Results  Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma system implementation, mortality was reduced by 8% (95% confidence interval [CI], 3%-12%) after adjusting for secular trends in crash mortality, age, and the introduction of traffic safety laws. Implementation of primary enforcement of restraint laws and laws deterring drunk driving resulted in reductions in crash mortality of 13% (95% CI, 11%-16%) and 5% (95% CI, 3%-7%), respectively, while relaxation of state speed limits increased mortality by 7% (95% CI, 3%-10%).

Conclusions  Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 years, a finding consistent with the maturation and development of trauma triage protocols, interhospital transfer agreements, organization of trauma centers, and ongoing quality assurance.

Author Affiliations: Department of Surgery, Harborview Medical Center and the Harborview Injury Prevention and Research Center, University of Washington, Seattle.

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