Evaluation of the Long-term Trend in Mortality from Injury in a Mature Inclusive Trauma System Lynne Moore • James A. Hanley • Alexis F. Turgeon • Andre ´ Lavoie Published online: 23 April 2010 Ó Socie ´te ´ Internationale de Chirurgie 2010 Abstract Background Organized trauma systems are designed to improve the quality and efficiency of trauma care. Several studies have reported mortality reductions during or immediately after implementation of a trauma system but little data are available on long-term trends. The aim of this study was to evaluate the long-term trend in risk-adjusted mortality in a mature inclusive trauma system. Methods The trauma system of the province of Quebec, Canada, was implemented in 1992 and completed in 1996. Data were drawn from the Quebec Trauma Registry with mandatory participation of all 59 centres, uniform inclusion criteria, and standardized data collection and validation procedures. Temporal trends from 1999 to 2006 were evaluated using adjusted estimates of hospital mortality generated with a random-intercept hierarchical logistic regression model. Estimates were adjusted using the Trauma Risk Adjustment Model (TRAM) score. Results The study population comprised 88,235 patients, including 4731 hospital deaths (5.4%). Crude mortality risk varied between 5.2% in 1999 and 4.6% in 2006. Adjusted mortality risk remained stable between 1999 and 2002, but a statistically significant decrease of 4.6% per year (95% CI = 0.9–8.5) was observed between 2002 and 2006. Conclusions The risk of hospital mortality in the Quebec trauma system decreased by 24% between 2002 and 2006. Results suggest that as inclusive and regionalized trauma systems mature, they may provide better care to trauma victims. Further research should attempt to identify deter- minants of the observed decrease within the system and evaluate quality of life among survivors. Introduction Trauma systems are based on an organized network designed to improve the quality and efficiency of care to victims of injury [1]. The concept of organized trauma care was founded in the US in the 1970s and was introduced in most major Canadian cities in the 1980s. The US, Canada, Australia, and Germany figure among the countries with the most advanced trauma systems. However, the first provincial trauma systems in Canada were not imple- mented until around 1992 and only 3 of the 13 provinces/ territories currently have comprehensive trauma systems [2]. Similarly, only eight states in the US have fully developed trauma systems [3], and the establishment of regionalized trauma care in the UK has been even slower [4]. Several studies have reported decreases in mortality during or immediately following the implementation of a This work was presented in part at the International Surgical Week conference in Adelaide, Australia, September 2009. L. Moore Á J. A. Hanley Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada L. Moore (&) Á A. F. Turgeon Á A. Lavoie Unite ´ de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Ho ˆpital de l’Enfant-Je ´sus), Universite ´ Laval, Quebec City, QC, Canada e-mail: lynne.moore.cha@ssss.gouv.qc.ca A. F. Turgeon De ´partement d’anesthe ´siologie, Division de soins intensifs, Ho ˆpital de l’Enfant-Je ´sus, Universite ´ Laval, Quebec City, QC, Canada A. Lavoie De ´partement de me ´decine sociale et pre ´ventive, Universite ´ Laval, Quebec City, QC, Canada 123 World J Surg (2010) 34:2069–2075 DOI 10.1007/s00268-010-0588-z