• Lynne Moore, David Evans, Sayed M Hameed, Natalie L Yanchar, Henry T Stelfox, Richard Simons, John Kortbeek, Gilles Bourgeois, Julien Clément, François Lauzier, Avery Nathens, and Alexis F Turgeon.
• *Department of Social and Preventative Medicine, Université Laval, Québec, Canada †Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada ‡Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada §Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ¶Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), Institute for Public Health, University of Calgary, Calgary, Alberta, Canada ||Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta, Canada **Institut national d'excellence en santé et en services sociaux (INESSS), Québec, Canada ††Department of Surgery, Université Laval, Québec, Canada ‡‡Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Canada §§Division of General Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
• Ann. Surg. 2017 Jan 1; 265 (1): 212-217.

ObjectiveTo measure the variation in trauma center mortality across Canadian trauma systems, assess the contribution of traumatic brain injury and thoracoabdominal injury to observed variations, and evaluate whether the presence of recommended trauma system components is associated with mortality.Summary Background DataInjuries represent one of the leading causes of mortality, disability, and health care costs worldwide. Trauma systems have improved injury outcomes, but the impact of trauma system configuration on mortality is unknown.MethodsWe conducted a retrospective cohort study of adults admitted for major injury to trauma centers across Canada (2006-2012). Multilevel logistic regression was used to estimate risk-adjusted hospital mortality and assess the impact of 13 recommended trauma system components.ResultsOf 78,807 patients, 8382 (10.6%) died in hospital including 6516 (78%) after severe traumatic brain injury and 749 (9%) after severe thoracoabdominal injury. Risk-adjusted mortality varied from 7.0% to 14.2% across provinces (P < 0.0001); 11.1% to 26.0% for severe traumatic brain injury (P < 0.0001), and 4.7% to 5.9% for thoracoabdominal injury (P = 0.2). Mortality decreased with increasing number of recommended trauma system elements; adjusted odds ratio = 0.93 (0.87-0.99).ConclusionsWe observed significant variation in trauma center mortality across Canadian provinces, specifically for severe traumatic brain injury. Provinces with more recommended trauma system components had better patient survival. Results suggest that trauma system configuration may be an important determinant of injury mortality. A better understanding of which system processes drive optimal outcomes is required to reduce the burden of injury worldwide.

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