• Jessica L Mckee, Derek J Roberts, Mary H van Wijngaarden-Stephens, Christine Vis, He Gao, Kathy L Belton, Don Voaklander, Chad G Ball, Ioana Bratu, Geoffrey C Ibbotson, Kevin Martin, Paul Engels, Damian Paton-Gay, Paul Parks, Lyle Thomas, Jonathan Guilfoyle, John B Kortbeek, Andrew W Kirkpatrick, and Provincial Trauma Committee of Alberta.
• *Alberta Center for Injury Control and Research, Edmonton †Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Canada ‡Department of Community Health Sciences (Division of Epidemiology), University of Calgary, Calgary, Canada §Department of Surgery, University of Alberta Hospital, Edmonton, Canada ¶Division of Critical Care, University of Alberta Hospital, Edmonton, Canada ‖Regional Trauma Services, University of Alberta Hospital, Edmonton, Canada **Stollery Children's Hospital, Edmonton, Canada ††Queen Elizabeth II Regional Hospital, Grand Prairie, Canada ‡‡Chinook Regional Hospital, Lethbridge, Canada §§Royal Alexandra Hospital, Edmonton, Canada ¶¶Medicine Hat Regional Hospital, Medicine Hat ‖‖Red Deer Regional Hospital, Red Deer, Canada; and ***Alberta Children's Hospital, Calgary, Canada †††Regional Trauma Services, Foothills Medical Centre, Calgary, Canada.
• Ann. Surg.. 2015 Mar 1;261(3):558-64.

ObjectiveTo evaluate the implementation of an all-inclusive philosophy of trauma care in a large Canadian province.BackgroundChallenges to regionalized trauma care may occur where transport distances to level I trauma centers are substantial and few level I centers exist. In 2008, we modified our predominantly regionalized model to an all-inclusive one with the hopes of increasing the role of level III trauma centers.MethodsWe conducted a population-based, before-and-after study of patient admission and transfer practices and outcomes associated with implementation of an all-inclusive provincial trauma system using multivariable Poisson and linear regression and Cox proportional hazard models.ResultsIn total, 21,772 major trauma patients were included. Implementation of the all-inclusive model of trauma care was associated with a decline in transfers directly to level I trauma centers [risk ratio (RR) = 0.91; 95% confidence interval (CI): 0.88-0.94; P < 0.001] and an increase in transfers from level III to level I centers (RR = 1.10; 95% CI: 1.00-1.21; P = 0.04). These changes in trauma care occurred in conjunction with a 12% reduction in the hazard of mortality (hazard ratio = 0.88; 95% CI: 0.84-0.98; P = 0.003) and a decrease in mean trauma patient hospital length of stay by 1 day (95% CI: 1.02-1.11; P = 0.02) after adjustment for differences in case mix.ConclusionsIn this study, introduction of an all-inclusive provincial trauma system was associated with an increased number of injured patients cared for in their local systems and improved trauma patient mortality and hospital length of stay.

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