Year: 2013
Type: dissertation
Abstract: Objectives: (1) To examine the association of transfer from a non-trauma hospital to a trauma centre, compared to direct transport to a trauma centre, on patient outcomes; (2) to describe temporal trends and provincial variations in major trauma hospitalization and outcomes; (3) to describe trends in the receipt of trauma centre care for severely injured patients; and (4) to identify factors associated with the receipt of trauma centre care. Methods: To address the first objective a systematic review and meta-analysis of published observational studies was performed. The remaining objectives were addressed as part of a population-based retrospective cohort study using the National Trauma Registry Minimum Dataset. Age-standardized hospitalization and death rates were calculated using the direct method. Multi-level logistic regression analyses were used to explore factors associated with receipt of trauma centre care. Results: The meta-analysis revealed no difference in mortality between direct and indirect admissions to a trauma centre (pooled odds ratio (OR), 1.06; 95% confidence interval (CI): 0.90 - 1.25). The population based study identified increasing hospitalization rates for major trauma among older Canadian patients (≥ 65 years) over the eight-year period (estimated annual percent increase of 3.3%;95% CI: 2.8% - 3.8%). Case fatality rates declined modestly. Overall, 41% of major trauma patients did not receive care in a trauma centre, ranging from 28% to 76% across the provinces. A disproportionately greater proportion of older Canadians did not receive care in a trauma centre. The odds of receiving care in a trauma centre were 64% lower among older compared to young patients. Compared to men, the odds of receiving care in a trauma centre were 21% lower amongst women (adjusted OR 0.79; 95% CI: 0.76, 0.82). These findings were consistent across the provinces. Conclusion: Major trauma hospitalization rates increased over the study interval. Moreover, decreased likelihood of trauma centre care was demonstrated for elderly patients and women. These findings highlight important opportunities for injury prevention and strategies to improve access to trauma centre care for patients. Further studies examining the underlying reasons for the gender and age disparity in access to trauma centre care are warranted.
Source: TSpace (University of Toronto)
Author: Andrea Hill
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2729962657