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Evolution of Patient Outcomes Over 14 Years in a Mature, Inclusive Canadian Trauma System

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Abstract

Background

The introduction of trauma systems in many countries worldwide has been shown to improve injury survival. However, few data are available on the long-term evolution of outcomes other than mortality. The objective of this study was to describe trends in mortality, unplanned readmission, complications, and length of stay in a mature inclusive trauma system from 1999 to 2012.

Methods

This retrospective cohort study was based on the inclusive trauma system of Quebec, Canada. Data were drawn from the trauma registry linked to the hospital discharge database. Time trends were evaluated using generalized linear mixed models with a correction for hospital clusters and cohort effects.

Results

Between 1999 and 2012, risk-adjusted mortality decreased from 5.8 to 4.2 % for all patients and from 14.9 to 13.1 % for major trauma (p < 0.0001). Mean LOS decreased from 9.5 days to 8.0 days for all patients and from 15.5 days to 11.5 days for major trauma (p < 0.0001). Unplanned readmission and complication rates remained stable over the observation period at around 6.6 and 11.6 % for all patients and 7.6 and 25.6 % for major trauma, respectively.

Conclusion

The results of this study suggest that there have been significant decreases in patient mortality and hospital length of stay in the inclusive trauma system of Québec over the last decade. Results also suggest that efforts should be made to reduce in-hospital complications and unplanned readmissions. Future research should attempt to identify determinants of observed decreases in mortality and LOS and assess whether similar improvements have occurred in functional outcomes.

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Conflict of interest

None.

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). 2.

Author information

Authors and Affiliations

  1. Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada

    Lynne Moore & Alexis F. Turgeon

  2. Axe Santé des Populations – Pratiques Optimales en Santé (Population Health – Practice-changing Research Unit), Traumatologie – Urgence – Soins intensifs (Trauma – Emergency – Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec – Hôpital de l’Enfant-Jésus), Université Laval, 1401, 18e rue, local H-012a, Quebec, QC, G1J 1Z4, Canada

    Lynne Moore, Alexis F. Turgeon, François Lauzier, Marcel Émond & Simon Berthelot

  3. Division of Critical Care Medicine, Department of Anesthesiology, Laval University, Quebec, QC, Canada

    Alexis F. Turgeon & François Lauzier

  4. Department of Internal Medicine, Laval University, Quebec, QC, Canada

    François Lauzier

  5. Department of Family Medicine and Emergency Medicine, Laval University, Quebec, QC, Canada

    Marcel Émond & Simon Berthelot

  6. Department of Surgery, Laval University, Quebec, QC, Canada

    Julien Clément

  7. Institut national d’excellence en santé et en services sociaux, Montreal, QC, Canada

    Gilles Bourgeois & Jean Lapointe

Authors
  1. Lynne Moore
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  2. Alexis F. Turgeon
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  3. François Lauzier
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  4. Marcel Émond
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  5. Simon Berthelot
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  6. Julien Clément
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  7. Gilles Bourgeois
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  8. Jean Lapointe
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Correspondence to Lynne Moore.

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Moore, L., Turgeon, A.F., Lauzier, F. et al. Evolution of Patient Outcomes Over 14 Years in a Mature, Inclusive Canadian Trauma System. World J Surg 39, 1397–1405 (2015). https://doi.org/10.1007/s00268-015-2977-9

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  • DOI: https://doi.org/10.1007/s00268-015-2977-9

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