Thirty Years of Trauma: The Evolution of the Trauma Patient in the San Diego County Trauma System

Background:  August 1, 2014 marks the 30-year anniversary of the San Diego County Trauma System, one of the first comprehensive trauma systems in the country.  We hypothesized that trauma related legislation and improving trauma care may have transformed the trauma patient profile and improved trauma outcomes over this three-decade period.

Methods:  We assessed the change in external cause of injury, outcomes, and total volume of trauma patients over a 30-year period.  To better understand these changes, we also described the 30-year history of aspects related to the trauma system, including data collection, inclusion criteria, and trauma-related legislation.

Results:  Originally, motor vehicle crash injuries represented almost 40% of trauma patient volume, but through safety advances, have fallen to less than 15% today.  Conversely, fall-related patients, initially less than 10% of volume, have steadily increased, now representing 37% of all patients. The mortality rate of severely injured trauma patients has decreased by 70% over 30 years.  Annual trauma center volume increased by 253% from 1984 to 2012. Blunt injuries increased by 191%. Penetrating injuries are similar to 30 years ago, but have fluctuated considerably.  Population controlled rates show a 29% decrease in penetrating injuries and a 96% increase in blunt injuries.

Conclusions: Over three decades, the improvement in trauma outcomes and changes in trauma patient profile have been affected by many issues.  The trauma system must recognize these issues and their implications for the future in order to deliver continued high-quality trauma care for severely injured patients over the next 30 years.