Original communicationAnalysis of trends in the Florida Trauma System (1991-2003): Changes in mortality after establishment of new centers
Section snippets
Florida trauma centers
Florida’s first trauma legislation, passed in 1982, required the Department of Health and Rehabilitative Services to define criteria for trauma center designation, verify hospital compliance with these criteria, and designate appropriately qualified hospitals as Level I, II, or Regional Pediatric Trauma Referral Centers (RPTRC). In 1991, the initial year of this study, there were 11 DTCs. Six additional centers were established between 1992 and 1994 whereas 3 others were added in, respectively,
Data and methods
This analysis combines information from the Florida Inpatient Hospital Discharge and Financial Datasets compiled by Florida’s Agency for Health Care Administration (AHCA). The datasets cover all acute care hospitals in the state. The discharge dataset contains demographic and case-mix related characteristics, including age, gender, ethnic origin, up to 9 diagnoses and procedures, source of admission, and discharge status of all hospitalized patients. The financial dataset contains data
Trauma admissions
Figure 1 shows the quarterly trend for trauma cases in all Florida hospitals from 1991 to 2003. The first quarter of each year is indicated by a solid bar, followed by outlined bars for the remaining three quarters. The solid line flowing from left to right is the annual moving average of trauma cases. Fig 1 A includes all cases and indicates a clear seasonal pattern, with a steady reduction in the number of trauma cases during the second and third quarters, followed by a sharp increase during
Results of multivariate analysis: The role of experience
The multivariate model was executed separately for 2 different specifications of the time elapsed since trauma center designation. The results are shown in the Table. Only the estimates associated with the time variables are shown in the Table. The statistical control factors are discussed in previous reports and are not included here to conserve space but are available from the authors on request. The first set of equations contained a single variable indicating the number of years elapsed.
Trends
This trend analysis of an established state trauma system demonstrates areas of dramatic change as well as evolving challenges to future function. Many of these trends are unique to specific patient age groups. Trauma admissions increased for ELD (relative and absolute), decreased for PEDS (relative and absolute), and were unchanged for ADLT (absolute). Unlike PEDS and ELD, ADLT trauma hospitalizations did not exhibit a seasonal pattern. Trauma hospitalizations for the elderly peaked in winter,
Conclusions
In Florida, the annual number of trauma victims increased among non-elderly adults and the elderly from 1991 to 2003. For the elderly, the upward trend is both absolute and relative to the size of the population. For children, trauma hospitalizations decreased both in absolute terms and as a percentage of the population. On average, adult patients admitted to more established DTCs had a lesser probability of mortality compared to trauma victims admitted to newly designated trauma institutions.
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Cited by (25)
Impact of lower level trauma center proliferation on patient outcomes
2024, Surgery Open ScienceEvolution and organisation of trauma systems
2019, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :In a meta-analysis published in 2006 and which included 14 studies, a benefit for the establishment of a trauma systems was found in 8 studies and overall implementation of such system was associated with a 15% mortality decrease [4]. Similar or superior results have been also found in other studies [21,22]. Tinkoff et al. described a decrease of more than 25% in mortality [23].
Trauma Systems: Origins, Evolution, and Current Challenges
2017, Surgical Clinics of North AmericaCitation Excerpt :As demonstrated in Florida, increasing the number of trauma centers alone does not improve the quality of care provided to injured patients within a community. Rather, improving care relies on providing access to seasoned trauma centers with adequate volume of trauma experience to continually adjust and improve treatment paradigms.30 As the landscape of trauma care changed in the 1990s, the need for an increased focus on systems of trauma centers became apparent.
Identification of an age cutoff for increased mortality in patients with elderly trauma
2010, American Journal of Emergency MedicineCitation Excerpt :A wide range of ages has been used to define elderly in the trauma literature. Proposed ages have ranged from 50 [9] through 55 [17-22], 60 [23], 65 [3,4,24-32], 70 [33,34], 75 [35] and as high as 80 years old [10]. Based on data from the Ohio Trauma Registry, we have identified age 70 as an important threshold for increased mortality from trauma.
Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?
2008, Journal of Pediatric SurgeryCitation Excerpt :All arguments also apply to the second comparison of PDTC vs NPDTC. Triage of patients with trauma to a DTC is expected to be nonrandom [16,17]. Florida's emergency medical services protocol dictates that patients should be transported to the nearest emergency department or DTC in case of a trauma alert.
This analysis is a further development of the Comprehensive Analysis of the Florida Trauma System, which was funded by the Florida Department of Health in 2004-2005.