Progress in the development of trauma systems in the United States. Results of a national survey

Objective. —To examine the status of trauma system development and key structural and operational characteristics of these systems. Design and Setting. —National survey of trauma systems with enabling state statute, regulation, or executive orders and for which designated trauma centers were present. Participants. —Trauma system administrators and directors of 37 state and regional organizations that had legal authority to administer trauma systems, which represented a response rate of 90.2%. Main Outcome Measures. —Trauma system components that had been implemented or were under development. Results. —From 1988 to 1993, the number of states meeting one set of criteria for a complete trauma system criteria increased from two to five. The most common deficiency in establishing trauma systems was failure to limit the number of designated trauma centers based on community need. Although most existing trauma systems have developed formal processes for designating trauma centers, prehospital triage protocols to allow hospital bypass, and centralized trauma registries, several systems lack standardized policies for interhospital transfer and systemwide evaluation. Conclusion. —State and regional organizations have accomplished a great deal but still have substantial work ahead in developing comprehensive trauma systems. Research is needed to better understand the relationship between trauma volume and outcomes of care as well as the impact of trauma system structure and operational characteristics on care delivery. Improved measures of patient outcome are also needed so that effective system evaluation can take place. (JAMA. 1995;273:395-401)