142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

310187
Thirty Years of Trauma: The Evolution of the Trauma Patient in the San Diego County Trauma System

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 1:30 PM - 1:45 PM

Joshua Smith, PhD, MPH , Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, CA
Candy Schoenheith, RN, BSN, PHN, MICN , Health and Human Services, Emergency Medical Services, County of San Diego, San Diego, CA
Barbara M. Stepanski, MPH , Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, CA
Amelia Kenner Brininger, MPH, CPH , Emergency Medical Services, County of San Diego, San Diego, CA
Isabel Corcos, PhD, MPH , County of San Diego, Emergency Medical Services, County of San Diego, San Diego, CA
Ryan Smith, MPH , Emergency Medical Services, County of San Diego, San Diego, CA
Alicia Sampson, MPH, CPH , Health & Human Services Agency, Public Health Services, County of San Diego, San Diego, CA
Leslie Ray, MPH, MPPA, MA , Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, CA
Alan Smith, PhD, MPH , Trauma Division, University of California, San Diego, San Diego, CA
Background:  August 1, 2014 marks the 30-year anniversary of the San Diego County Trauma System, one of the first comprehensive trauma systems in the country.  We hypothesized that trauma related legislation and improving trauma care may have transformed the trauma patient profile and improved trauma outcomes over this three-decade period.

Methods:  We assessed the change in external cause of injury, outcomes, and total volume of trauma patients over a 30-year period.  To better understand these changes, we also described the 30-year history of aspects related to the trauma system, including data collection, inclusion criteria, and trauma-related legislation.

Results:  Originally, motor vehicle crash injuries represented almost 40% of trauma patient volume, but through safety advances, have fallen to less than 15% today.  Conversely, fall-related patients, initially less than 10% of volume, have steadily increased, now representing 37% of all patients. The mortality rate of severely injured trauma patients has decreased by 70% over 30 years.  Annual trauma center volume increased by 253% from 1984 to 2012. Blunt injuries increased by 191%. Penetrating injuries are similar to 30 years ago, but have fluctuated considerably.  Population controlled rates show a 29% decrease in penetrating injuries and a 96% increase in blunt injuries.

Conclusions: Over three decades, the improvement in trauma outcomes and changes in trauma patient profile have been affected by many issues.  The trauma system must recognize these issues and their implications for the future in order to deliver continued high-quality trauma care for severely injured patients over the next 30 years.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Assess the change in external cause of injury among trauma victims over a 30-year period. Compare outcomes of severely injured trauma patients over a 30-year period. Describe the 30-year history of the San Diego County Trauma System, including data collection and trauma-related legislation.

Keyword(s): Emergency Medical Services, Health Systems Transformation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the County of San Diego epidemiologist responsible for the San Diego County Trauma System central trauma registry.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3259.0: Emergency medical services