Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109111

Robert M. Saywell, PhD, MPH¹, George H. Rodman, MD², Lawrence Lottenberg, MD³, Michael J. Przybylski, PhD⁴, Joseph J. Tepas, MD⁵, Patrick D. Kilgo, MS⁶, Steve Dearwater, MS⁷, and Jacqueline M. Hirth⁴. (1) Department of Family Medicine, Indiana University School of Medicine, 1110 West Michigan Street, Indianapolis, IN 46202-5102, (2) Trauma Program, Clarian-Methodist Hospital, 1701 North Senate, Indianapolis, IN 46202-5306, (3) Trauma, Burns and Emergency Surgery, Shands Hospital at the University of Florida, 1600 SW Archer, Gainesville, FL 32610, (4) Bowen Research Center, Indiana University School of Medicine, Long Hospital Second Floor, 1110 West Michigan, Indianapolis, IN 46202-5102, 317-278-0345, jhirth@iupui.edu, (5) Trauma Surgery, Shands Hospital at Jacksonville, 655 West Eighth Street, Jacksonville, FL 32209, (6) Public Health Sciences Department, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, (7) Jackson Memorial Hospital, P O Box 016820 (D-820), Miami, FL 33101

Purpose: The purpose of this study was: 1] to determine the feasibility of using hospital discharge data to assess the performance of a state-wide trauma system; 2] to examine whether differences in the distribution of high-risk trauma patients to trauma centers exist in a mandated trauma system compared to a non-mandated trauma system; and, 3] to determine the presence of differences in survival rates, patterns of care, hospital lengths of stay and the proportion discharged home for high-risk trauma patients in a mandated and non-mandated trauma system. Methods: Two years (1999-2000) of hospital trauma patient discharge data from Florida (mature trauma system) and Indiana (immature trauma system) were analyzed to describe trauma center distribution for high-risk patients (ISS>25) in four age groups (age <16; 16-44; 45-64; 65+), treatment differences, survival rates, length of hospital stay (HLOS), and need for post-hospital institutional care in the two states. Results: High-risk (ISS>25) adults but not children receive trauma center care more frequently in Florida compared with Indiana. Florida patients are older, have higher mortality rates and have longer hospital lengths of stay. However, the proportion discharged home did not differ between Florida and Indiana. Tracheostomy, caval filter, and bronchoscopy rates are higher in Florida compared to Indiana. Conclusions: Hospital discharge data can demonstrate the expected patient distribution difference when comparing a mature trauma system with a voluntary evolving system. Unexpected treatment and outcome differences in these two systems warrant more analysis using exact patient matching techniques. (243 words)

Learning Objectives:

• recognize the feasibility of using hospital discharge data to assess the performance of state-wide trauma systems
• see evidence that differences in the distributuion of high-risk trauma patients differ between mandated and non-mandated trauma systems
• recognize that differneces in survival rates, patterns of care, hospital lengths of stay and discharge status may vary between a mandated and non-mandated system

Keywords: Emergency, Service Delivery

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.