April 17, 2000
Organized systems of trauma care improve survival rates for car-crash victims
MP>Implementation of organized systems of trauma care reduce death rates due to motor-vehicle crashes by 9 percent, according to a study by researchers at Harborview Medical Center. The study will be published in the April 19 issue of the Journal of the American Medical Association.
The study, based on statistics from the 22 states that had developed organized systems of trauma care by 1995, includes data on fatal car crashes during the years 1979-1995 involving a driver or front-seat passenger between 15 and 74 years of age.
Each state was compared for mortality rates before and after its trauma system was implemented. A reduction in car-crash fatalities was noted eight years after the start of organized trauma systems, with a statistically significant decrease (9 percent) occurring after approximately 12 years.
“Our finding that the positive effect of trauma systems on mortality evolves over time is plausible,” explains Dr. Avery Nathens, University of Washington (UW) fellow in trauma and critical care, and principal investigator of this study. “Trauma-center protocols mature over time, triage policies are implemented, and referral patterns and transfer policies change. But all require time. Ultimately, patient outcomes improve.”
Despite reductions in mortality rates due to traffic crashes, they are still the single most important cause of injury death, with 41,480 people dying in crashes in 1998. Improvements in automotive and road design, safety-restraint laws, and laws restricting drinking and driving have all contributed to reduced mortality rates. The Harborview study is the most thorough evaluation of the contribution of organized trauma systems to the decrease in car-crash mortality rates.
“State or regional trauma systems were developed to ensure that patients with severe injuries are identified and transported to medical centers appropriate to the level of care they need,” says Dr. Ronald Maier, UW professor of surgery, surgeon-in-chief at Harborview and a co-investigator of this study. “This study shows that implementation of an organized system of trauma care results in a measurable decrease in crash mortality.”
The 22 states that organized systems of trauma care between 1979 and 1995 are California, Connecticut, the District of Columbia, Florida, Georgia, Illinois, Maryland, Massachusetts, Missouri, Nevada, New Jersey, New York, North Carolina, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Virginia, Washington and West Virginia,
In addition to Nathens and Maier, the study was authored by Dr. Gregory Jurkovich, UW professor of surgery and chief of trauma at Harborview; Dr. Peter Cummings, UW assistant professor of epidemiology; and Dr. Frederick Rivara. UW professor of pediatrics and co-director of the Harborview Injury Prevention and Research Center.