Context Despite calls for wider national implementation of an integrated approach
to trauma care, the effectiveness of this approach at a regional or state
level remains unproven.
Objective To determine whether implementation of an organized system of trauma
care reduces mortality due to motor vehicle crashes.
Design Cross-sectional time-series analysis of crash mortality data collected
for 1979 through 1995 from the Fatality Analysis Reporting System.
Setting All 50 US states and the District of Columbia.
Subjects All front-seat passenger vehicle occupants aged 15 to 74 years.
Main Outcome Measures Rates of death due to motor vehicle crashes compared before and after
implementation of an organized trauma care system. Estimates are based on
within-state comparisons adjusted for national trends in crash mortality.
Results Ten years following initial trauma system implementation, mortality
due to traffic crashes began to decline; about 15 years following trauma system
implementation, mortality was reduced by 8% (95% confidence interval [CI],
3%-12%) after adjusting for secular trends in crash mortality, age, and the
introduction of traffic safety laws. Implementation of primary enforcement
of restraint laws and laws deterring drunk driving resulted in reductions
in crash mortality of 13% (95% CI, 11%-16%) and 5% (95% CI, 3%-7%), respectively,
while relaxation of state speed limits increased mortality by 7% (95% CI,
Conclusions Our data indicate that implementation of an organized system of trauma
care reduces crash mortality. The effect does not appear for 10 years, a finding
consistent with the maturation and development of trauma triage protocols,
interhospital transfer agreements, organization of trauma centers, and ongoing