ORIGINAL ARTICLES

Mortality in Canadian Trauma Systems

A Multicenter Cohort Study

Moore, Lynne PhD; Evans, David MD, FRCSC, FACS; Hameed, Sayed M. MD, MPh, FRCSC, FACS; Yanchar, Natalie L. MD, MSc, FRCSC; Stelfox, Henry T. MD, PhD, FRCPC; Simons, Richard MA, FRCSC, FACS; Kortbeek, John MD, FRCSC, FACS; Bourgeois, Gilles MD; Clément, Julien MD, FRCSC; Lauzier, François MD, MSc, FRCPC; Nathens, Avery MD, PhD, FRCSC; Turgeon, Alexis F. MD, MSc, FRCPC

Author Information

*Department of Social and Preventative Medicine, Université Laval, Québec, Canada

†Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie – Urgence – Soins intensifs (Trauma – Emergency – Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l’Enfant-Jésus), Université Laval, Québec, Canada

‡Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada

§Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada

Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), Institute for Public Health, University of Calgary, Calgary, Alberta, Canada

||Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta, Canada

**Institut national d’excellence en santé et en services sociaux (INESSS), Québec, Canada

††Department of Surgery, Université Laval, Québec, Canada

‡‡Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Canada

§§Division of General Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.

Reprints: Lynne Moore, PhD, CHU de Québec Research Center (Enfant-Jésus Hospital), Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie – Urgence – Soins intensifs (Trauma – Emergency – Critical Care Medicine), 1401, 18e rue, local H-012a, Québec, Canada G1J 1Z4. E-mail: [email protected]

Financial support: Canadian Institutes of Health Research: New Investigator Award (HTS and LM) and research grant (LM; #110996); Fonds de la Recherche du Québec - Santé: clinician-scientist award (AFT, FL).

The author reports no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.annalsofsurgery.com).

Annals of Surgery 265(1):p 212-217, January 2017. | DOI: 10.1097/SLA.0000000000001614

Abstract

Objective: 

To measure the variation in trauma center mortality across Canadian trauma systems, assess the contribution of traumatic brain injury and thoracoabdominal injury to observed variations, and evaluate whether the presence of recommended trauma system components is associated with mortality.

Summary Background Data: 

Injuries represent one of the leading causes of mortality, disability, and health care costs worldwide. Trauma systems have improved injury outcomes, but the impact of trauma system configuration on mortality is unknown.

Methods: 

We conducted a retrospective cohort study of adults admitted for major injury to trauma centers across Canada (2006–2012). Multilevel logistic regression was used to estimate risk-adjusted hospital mortality and assess the impact of 13 recommended trauma system components.

Results: 

Of 78,807 patients, 8382 (10.6%) died in hospital including 6516 (78%) after severe traumatic brain injury and 749 (9%) after severe thoracoabdominal injury. Risk-adjusted mortality varied from 7.0% to 14.2% across provinces (P < 0.0001); 11.1% to 26.0% for severe traumatic brain injury (P < 0.0001), and 4.7% to 5.9% for thoracoabdominal injury (P = 0.2). Mortality decreased with increasing number of recommended trauma system elements; adjusted odds ratio = 0.93 (0.87–0.99).

Conclusions: 

We observed significant variation in trauma center mortality across Canadian provinces, specifically for severe traumatic brain injury. Provinces with more recommended trauma system components had better patient survival. Results suggest that trauma system configuration may be an important determinant of injury mortality. A better understanding of which system processes drive optimal outcomes is required to reduce the burden of injury worldwide.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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