Influence of a statewide trauma system on pediatric hospitalization and outcome

J Trauma. 1997 Mar;42(3):514-9. doi: 10.1097/00005373-199703000-00020.


Background: During the years 1987-1991, a statewide trauma system was implemented in Oregon (Ore) but not in Washington (Wash). Incidence of hospitalization, frequency of death and risk-adjusted odds of death for injured children (< 19 years) in the two adjacent states were compared for two time periods (1985-1987 and 1991-1993).

Methods: State populations of injured children (International Classification of Diseases, 9th Revision-Clinical Modification, code 800-959) were identified through a Hospital Discharge Index. Hospitals in counties with a population density < 50 persons/square mile were designated rural. Incidence rates are events/10,000 pediatric population per year.

Results: The pediatric population increased in both states (Ore: 687,000-758,000; Wash: 1,159,000-1,336,000). Incidence of hospitalization for all injured children in entire states declined (Ore: 66.5-38.5; Wash: 54-33); also in rural hospitals (Ore: 67.5-32; Wash: 48 to 31). Seriously injured children (score on the Injury Severity Scale > 15) had a lower incidence in 1991-1993 of admission to rural hospitals (Ore: 2.98; Wash: 2.82) compared with incidence for entire states (Ore: 4.61; Wash: 4.62); in 1985-1987 the incidence was not different. Furthermore risk adjusted odds of death for seriously injured children was significantly lower in Oregon than in Washington in the later time period.

Conclusion: Both states show a similar temporal trend toward a declining frequency of death for children hospitalized with injuries. Injury prevention strategies appear to have reduced the number of serious injuries in both states. However, seriously injured children demonstrated a reduced risk of death in Oregon, consistent with benefit from a statewide trauma system.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Hospitalization / statistics & numerical data*
  • Hospitals, Rural
  • Hospitals, Urban
  • Humans
  • Infant
  • Injury Severity Score
  • Male
  • Oregon / epidemiology
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Risk Assessment
  • Trauma Centers / statistics & numerical data
  • Treatment Outcome
  • Washington / epidemiology
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / mortality
  • Wounds and Injuries / therapy*