Preferential benefit of implementation of a statewide trauma system in one of two adjacent states. Discussion.
Annual Meeting of the American Association for Surgery of Trauma and the Japanese Association for Acute Medicine. Waikoloa, HI, USA, 1997/09/24.
Implementation of Oregon's trauma system was associated with a reduction in the risk of death for hospitalized injured patients.
An alternative explanation for improved outcome, however, is favorable concurrent temporal trends, e.g., new technologies and treatments.
Patients and Methods
To control for temporal trends, seriously injured hospitalized patients in Oregon and Washington were compared before either state had a trauma system (1985-1988) and when only the Oregon trauma system had been implemented (1990-1993).
The study group consisted of hospitalized injured patients aged 16 to 79 years with one or more index injuries in six body regions, i.e., head, chest, spleen/liver, femur or pelvis fracture, and burns.
Hospital discharge claims data were analyzed, converting International Classification of Diseases, Ninth Revision, Clinical Modification, discharge diagnosis codes to Abbreviated Injury Scale scores and Injury Severity Scores using a conversion algorithm.
Multivariate logistic regression models were used to estimate the differential risk-adjusted odds of death in Oregon compared with Washington after adjustment for demographics, injury type, and injury severity.
Findings indicated no difference in the risk-adjusted odds of death between Oregon and Washington while both states functioned under an ad hoc trauma system (1985-1988). (...)
Mots-clés Pascal : Traumatologie, Organisation, Région géographique, Système santé, Relation, Evolution, Mortalité, Etude critique, Homme
Mots-clés Pascal anglais : Traumatology, Organization, Geographical division, Health system, Relation, Evolution, Mortality, Critical study, Human
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0238021
Code Inist : 002B30A06D. Création : 11/09/1998.