Evolution of a Level I Trauma System: changes in injury mechanism and its impact in the delivery of care.

Background: Mechanisms of injury in trauma populations evolve over time as a result of system changes, prevention and safety activities, and shifts in population composition. Such changes have implications for reimbursement and resource utilization within all trauma centers. This study examines the evolution of trauma mechanisms at a regional Level I trauma center over 10 years to document the impact of these changes.

Methods: After IRB approval, the trauma registry was queried for total trauma admissions over 10 years. Data points of mechanism of injury, ISS, age, mortality, financial information, and discharge disposition were obtained. Statistical significance was determined by Chi square analysis.

Results: Total admissions increased steadily over the course of the 10 years studied. The percentage of motor vehicle crashes (MVC) decreased, while falls increased. Fall patients were older, with lower ISS and with longer length of stay. Mortality rates were higher, but statistically similar to those of the population as a whole. Fall patients were more frequently discharged to skilled nursing facilities. Federally supported Medicare programs increased steadily as a portion of payer mix.

Conclusions: Mechanism of injury within our regional Level I trauma center changed over time with MVC as a percentage of blunt trauma mechanisms decreasing as falls increased. Falls are now a leading mechanism for traumatic injury, even at tertiary referral systems, and will continue to rise in incidence as the population of America ages. This change has direct implications for reimbursement and resource utilization. Current scoring systems employed by trauma centers do not predict this trend well.