Assessing effectiveness of a mature trauma system: Association of trauma center presence with lower injury mortality rate.

OBJECTIVE:: To determine effectiveness of trauma center care in a mature trauma system by comparing motor vehicle crash (MVC) death rates in counties with a trauma center (TC) to those without a trauma center (NTC). METHODS:: State data for MVCs occurring in 2003 were analyzed. Fatalities from crashes in counties with a TC were compared with NTC counties. The primary outcome was case-fatality rate and the secondary outcome was crash-fatality rate. Data from 67 Florida counties and 20 TCs were assessed. Covariates such as age, speed, alcohol use, prehospital resources, and rural/urban location were adjusted for in the analysis. RESULTS:: The statewide incidence of fatality from MVC in 2003 was 18.6 per 100,000. The overall state case-fatality rate was 2.8% (95% CI = 2.4-3.3). There were 13 TC counties with a mean fatality rate of 17.7 per 100,000 (95% CI = 14.5-20.9) and 54 NTC counties with a mean fatality rate 33.4 per 100,000 (95% CI = 28.8-38.0; p Language: en