Canadian Trauma System Research Articles

An inventory of Canadian trauma systems: opportunities for improving access to trauma care.

Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care. We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A "snowball" approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region. The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system. There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.

Influence of Socioeconomic Status on Trauma Center Performance Evaluations in a Canadian Trauma System

Trauma center performance evaluations generally include adjustment for injury severity, age, and comorbidity. However, disparities across trauma centers may be due to other differences in source populations that are not accounted for, such as socioeconomic status (SES). We aimed to evaluate whether SES influences trauma center performance evaluations in an inclusive trauma system with universal access to health care. The study was based on data collected between 1999 and 2006 in a Canadian trauma system. Patient SES was quantified using an ecologic index of social and material deprivation. Performance evaluations were based on mortality adjusted using the Trauma Risk Adjustment Model. Agreement between performance results with and without additional adjustment for SES was evaluated with correlation coefficients. The study sample comprised a total of 71,784 patients from 48 trauma centers, including 3,828 deaths within 30 days (4.5%) and 5,549 deaths within 6 months (7.7%). The proportion of patients in the highest quintile of social and material deprivation varied from 3% to 43% and from 11% to 90% across hospitals, respectively. The correlation between performance results with or without adjustment for SES was almost perfect (r = 0.997; 95% CI 0.995-0.998) and the same hospital outliers were identified. We observed an important variation in SES across trauma centers but no change in risk-adjusted mortality estimates when SES was added to adjustment models. Results suggest that after adjustment for injury severity, age, comorbidity, and transfer status, disparities in SES across trauma center source populations do not influence trauma center performance evaluations in a system offering universal health coverage.

The influence of socioeconomic disparities across source populations on the results of trauma centre performance evaluations in a Canadian trauma system

The evaluation of acute trauma care is essential to the effort of alleviating the societal burden of injury. Trauma centre performance evaluations generally include adjustment for anatomic injury severity, physiological...

Association between socioeconomic status and access to trauma care for victims of injury in a Canadian trauma system

The association between low socioeconomic status (SES) and increased population-based risk of injury is well documented. However, little is known about the association between SES and access to trauma care....

Association Between Alcohol and Mortality in Patients With Severe Traumatic Head Injury—Invited Critique

Invited comments upon: Arch Surg. 2006;141(12):1185-1191. This is a well-designed, retrospective study using a large Canadian trauma system database. Tien et al examine the hypothesis that admission blood alcohol concentration is associated with in-hospital death in patients with severe brain injury from blunt head trauma. There is a long-held myth that intoxicated trauma victims are more relaxed and, therefore, fare better than nonintoxicated patients. In the interest of public health, this is a myth to be discredited. However, this study did find that the cohort of patients with severe TBI and a low BAC had a higher survival rate than those with no BAC. This finding should stimulate clinical research to better understand the potential neuroprotective effects of a low BAC, but it should clearly not be a call for trauma patients with severe TBI to premedicate with alcohol. Rather, the emphasis more appropriately should be placed on the fact that 30% to 50% of all hospitalized trauma patients are intoxicated at the time of injury. Conversely, a high BAC was associated with higher mortality. This suggests a detrimental effect of a high BAC on homeostasis (eg, hypotension), and we know that hypotension is a critical, negative factor in secondary brain injury. This finding should also stimulate clinical research to better understand and counter these negative physiologic changes. It also speaks to the trauma prevention dictum that decries drinking and driving. This study should be further impetus for clinical research that will better define the dose-related effect, positive or negative, of alcohol on the physiologic status and outcome in patients with severe TBI. Perhaps this research can help answer the question as to whether there is a therapeutic role for alcohol in our management of the patient with severe TBI after adequate resuscitation.