Evaluation of the Long-term Trend in Mortality from Injury in a Mature Inclusive Trauma System

Organized trauma systems are designed to improve the quality and efficiency of trauma care. Several studies have reported mortality reductions during or immediately after implementation of a trauma system but little data are available on long-term trends. The aim of this study was to evaluate the long-term trend in risk-adjusted mortality in a mature inclusive trauma system. The trauma system of the province of Quebec, Canada, was implemented in 1992 and completed in 1996. Data were drawn from the Quebec Trauma Registry with mandatory participation of all 59 centres, uniform inclusion criteria, and standardized data collection and validation procedures. Temporal trends from 1999 to 2006 were evaluated using adjusted estimates of hospital mortality generated with a random-intercept hierarchical logistic regression model. Estimates were adjusted using the Trauma Risk Adjustment Model (TRAM) score. The study population comprised 88,235 patients, including 4731 hospital deaths (5.4%). Crude mortality risk varied between 5.2% in 1999 and 4.6% in 2006. Adjusted mortality risk remained stable between 1999 and 2002, but a statistically significant decrease of 4.6% per year (95% CI = 0.9-8.5) was observed between 2002 and 2006. The risk of hospital mortality in the Quebec trauma system decreased by 24% between 2002 and 2006. Results suggest that as inclusive and regionalized trauma systems mature, they may provide better care to trauma victims. Further research should attempt to identify determinants of the observed decrease within the system and evaluate quality of life among survivors.