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Original Investigation
November 09, 2016

Trends in Injury Outcomes Across Canadian Trauma Systems

Author Affiliations
  • 1Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
  • 2Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, and Critical Care Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
  • 3Department of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
  • 4Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
  • 5Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
  • 6Division of General Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
  • 7Institut National d’Excellence en Santé et en Services Sociaux, Québec, Québec City, Canada
  • 8Department of Surgery, Université Laval, Québec, Québec City, Canada
  • 9Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Québec City, Canada
JAMA Surg. Published online November 9, 2016. doi:10.1001/jamasurg.2016.4212
Key Points

Question  How have mortality, hospital length of stay, and unplanned readmission evolved in Canadian trauma systems between 2006 and 2012?

Findings  This national cohort study found a statistically significant decrease in risk-adjusted mortality incidence (from 12.1% to 9.9%) and mean hospital length of stay (from 11.6 to 10.6 days), but no change in incidence of unplanned readmissions. Trends varied across provinces.

Meaning  Improvements in injury outcomes were observed in some Canadian provinces between 2006 and 2012, indicating that the configuration of trauma systems may be influential.


Importance  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.

Objective  To evaluate trends in mortality, hospital length of stay, and unplanned readmission in Canadian trauma systems between 2006 and 2012.

Design, Setting, and Participants  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.

Exposures  Trauma centers and systems.

Main Outcomes and Measures  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.

Results  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%; P < .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 (P < .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%]; P < .001), Alberta (12% [95% CI, 10%-14.3%] to 9.1% [95% CI, 7.7%-10.8%]; P = .02), and Manitoba (13% [95% CI, 9.1%-18.4%] to 11.1% [95% CI, 8.3%-14.7%]; P = .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; P < .001), British Columbia (12.5 [95% CI, 12-13.1] to 11.4 [10.9-11.9] days; P < .001), and Ontario (10.1 [95% CI, 9.8-10.4] to 9.8 [95% CI, 9.5-10.1] days; P < .001). No change in the incidence of readmission was observed.

Conclusions and Relevance  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.