Reduction in trauma mortality in Israel during the last decade (2000-2010): The impact of changes in the trauma system

Hypothesis: Following the introduction of changes to the trauma system there would be a period of time during which the impact on mortality would be minimal. A decrease in mortality rates would be noted as the TS matured and would continue over time. Design: A retrospective cohort study of all severely injured patients (injury severity score >= 16) recorded in the Israeli National Trauma Registry at six level I trauma centres in Israel from 2000 to 2010. Inpatient death rates were examined overall and by sub groups. Setting: The National Trauma Registry contains hospitalized patients, transfer patients to or from other hospitals and those who died in the emergency department. It excludes patients who were dead on arrival, discharged following treatment in the emergency department, and patients whose injuries by definition are not classified as trauma. Main outcome measures: In-hospital mortality Results: Data included 23,143 severe trauma patients available for analysis. Inpatient mortality rates decreased significantly from 16% in 2000 to 11% in 2010. The odds ratio for mortality in 2010 vs. 2000, adjusted for year, age, sex, mechanism of injury, traumatic brain injury, penetrating injury, and severity of injury (ISS >= 25), was 0.53, confirming a downward trend. Conclusions: A steady significant reduction in the inpatient mortality rate for severe trauma patients hospitalized at all level I trauma centres in Israel between 2000 and 2010 was observed. Although a single factor that explains the reduction was not identified, evidently the establishment of the trauma system brought about a significant decrease in hospital mortality. Integrated cooperation between components of the national trauma system in Israel over the years may explain the reduction. (c) 2012 Elsevier Ltd. All rights reserved.