Fatality Analysis Reporting System Demonstrates Association between Trauma System Initiatives and Decreasing Death Rates

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Abstract
Trauma registries frequently do not include the deaths of patients who do not get to trauma centers (TCs). Thus, complementary methods of monitoring the impact of trauma system initiatives should be considered. The objective of this study is to use National Highway Safety Traffic Administration's Fatality Analysis Reporting System (FARS) and New York State Department of Motor Vehicles data and to study the impact of state and regional initiatives over a 10-year period in the seven-county Hudson Valley New York (HV) region with one regional TC in Westchester County (WC) and to assess its face validity. FARS data for the United States (US), New York State (NY), the HV region, and WC were analyzed from 1987 to 1996. Trauma system initiatives included the following. Statewide: (1) TC standards (1989), (2) TC designation and funding (1990), (3) State Trauma Advisory Committee (1991), (4) BLS triage protocol and trauma registry (1993), and (5) quality improvement site surveys (1994). Regional: (1) one regional and two area TCs (1990), (2) helicopter services (1992 and 1994), (3) two additional area TCs, and (4) E 911 in all three counties (1995). The results were presented to the New York State Trauma Advisory Committee. Although nationally motor vehicle crash deaths/100,000 persons have plateaued since 1991, trauma system initiatives have been temporally associated with death rates continuing to diminish in New York, the HV, and WC. From 1987 to 1996, the HV death rate dropped from 17.00 to 9.45, a 44% drop; and the WC rate dropped from 12.51 to 7.05, a 44% drop compared with United States death rate drop of 16% (p < 0.005). The percentage of seriously injured trauma patients going to the trauma centers increased from 53% in 1990 to 72% in 1995 (p < 0.001). The STAC felt that the data reflected in part effects of New York State trauma system initiatives. The drops in motor vehicle crash death rates may reflect injury prevention as well as trauma system initiatives. Thus, although FARS and New York State Department of Motor Vehicles data cannot establish cause and effect relationships, it can monitor the aggregated impact of multiple initiatives. Taken together with increasing percentages of seriously injured trauma patients going to trauma centers and comparisons with national FARS data, the association of decreasing deaths with the implementation of a trauma system seems to have face validity.