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• W2553514096 abstract "<h3>Importance</h3> In response to the burden of injury, the structure of injury care has changed considerably across Canada in the past decade. However, little is known about how patient outcomes have evolved. <h3>Objective</h3> To evaluate trends in mortality, hospital length of stay, and unplanned readmission in Canadian trauma systems between 2006 and 2012. <h3>Design, Setting, and Participants</h3> A pan-Canadian retrospective cohort study was conducted among adults admitted for major injury to a Canadian level I or II trauma center between April 1, 2006, and March 31, 2012. Data analysis was conducted from April 15 to December 3, 2015. <h3>Exposures</h3> Trauma centers and systems. <h3>Main Outcomes and Measures</h3> Multilevel generalized linear models were used to evaluate trends in the risk-adjusted incidence of mortality and readmission and risk-adjusted mean length of stay. Trend analyses were conducted globally and by province. <h3>Results</h3> Among 78 807 patients (mean [SD] age, 50.7 [22.0] years; 22 540 women and 56 267 men) admitted for major injury during the study period, risk-adjusted mortality decreased from 12.1% (95% CI, 9%-16.1%) to 9.9% (95% CI, 7.4%-13.3%;<i>P</i> < .001) and mean length of hospital stay decreased from 11.6 (95% CI, 9.9-13.6) to 10.6 (95% CI, 9.1-12.5) days (<i>P</i> < .001). Statistically significant reductions in mortality were observed for Ontario (12% [95% CI, 10.7%-13.6%] to 8% [95% CI, 6.9%-9.2%];<i>P</i> < .001), Alberta (12% [95% CI, 10%-14.3%] to 9.1% [95% CI, 7.7%-10.8%];<i>P</i> = .02), and Manitoba (13% [95% CI, 9.1%-18.4%] to 11.1% [95% CI, 8.3%-14.7%];<i>P</i> = .04). Risk-adjusted hospital stay decreased significantly in Québec (11.6 [95% CI, 11.1-12] to 9.1 [95% CI, 8.9-9.5] days;<i>P</i> < .001), British Columbia (12.5 [95% CI, 12-13.1] to 11.4 [10.9-11.9] days;<i>P</i> < .001), and Ontario (10.1 [95% CI, 9.8-10.4] to 9.8 [95% CI, 9.5-10.1] days;<i>P</i> < .001). No change in the incidence of readmission was observed. <h3>Conclusions and Relevance</h3> We observed an 18.2% relative decrease in risk-adjusted mortality in Canadian trauma centers during the study period, representing 248 additional lives saved in 2012 vs 2006. Risk-adjusted mean hospital stay decreased by 8.6%, representing nearly 10 000 hospital days saved. A better understanding of the structures and processes behind observed improvements is needed to further reduce the burden of injury in Canada." @default.
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• W2553514096 date "2017-02-01" @default.
• W2553514096 modified "2023-10-13" @default.
• W2553514096 title "Trends in Injury Outcomes Across Canadian Trauma Systems" @default.
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• W2553514096 doi "https://doi.org/10.1001/jamasurg.2016.4212" @default.
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