Delaware's Inclusive Trauma System: Impact on Mortality

Abstract

The impact of implementing an inclusive state trauma system on injury-related mortality for patients with life-threatening injuries was assessed. Using the state trauma registry, trauma patients evaluated in all of Delaware's acute care hospitals from 1998 to 2007 were identified. Patients were categorized by injury severity score (ISS) groups (1-9, 10-15, 16-24, and >24). Each category was analyzed by mortality and interfacility transfer rate to the Level I trauma center for each year. An analysis of the National Trauma Data Bank (NTDB) for these ISS groups and mortality was performed to provide a comparative benchmark. Chi(2) and analysis of variance were used where appropriate (p <or= 0.05). A total of 40,063 entries were identified within the state trauma registry for the 10-year study period. Mortality rates did not significantly differ for ISS categories except for ISS >24 group. For this group, there was an incremental mortality decrease from 45.7% (1998) to 20.5% (2007) (p <or= 0.0005). This rate of decrease in mortality was significantly greater than that displayed in the NTDB. The rate for the aggregate of all interfacility transfers and ISS >24 group managed at the Level I hospital significantly increased over the same period. Since its inception, Delaware's trauma system, in which all acute care hospitals participate, has been associated with an incremental, significant decrease in mortality of the most critically injured patients. This decrease is more substantial than that experienced nationally as depicted within the NTDB. These findings and our evolving experience support the concept and benefits of an "inclusive" trauma system.