Supplemental digital content 1. Trauma system definitions†
Whole system
All acute care hospitals within a region are integrated, each providing care for injured patients to the extent that their resources allow
Only those acute care hospitals with the most resources are designated as trauma centres and are considered part of the trauma system
Level I Central role in the provincial trauma system, and majority of tertiary/quaternary major trauma care in the system. Academic leadership, teaching, research program
Central role in the provincial trauma system, and majority of tertiary/quaternary major trauma care in the system. Academic leadership, teaching, research program
Level II Provides care for major trauma. Some trauma training and outreach programs. Similar to Level I without academic and research programs
Provides care for major trauma.
Some trauma training and outreach programs. Similar to Level I without academic and research programs
Level III Provides initial care for major trauma patients and transfers patients in need of complex care to Levels I and II trauma centers
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Level IV Major urban hospital with a nearby major trauma centre (Levels I–III). Does large volume of secondary trauma care. Bypass and triage protocols are in place diverting major trauma patients to level I and II centers
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Level IV Small rural community hospitals or treatment facilities with little to no immediate access to Level I, II, or III Trauma Centers. Most trauma patients are stabilized, if possible and rapidly transferred to higher level trauma care
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†Information adapted from
http://www.traumacanada.ca/accreditation_committee/Accreditation_Guidelines_2011.pdf
Supplemental Digital Content 2. Risk adjusted mortality incidence by province in sensitivity analyses
Risk-adjusted mortality (%)
BC AB MB ON QC NS NL Correlation with
whole sample*
All patients 8.1
(7.4-8.9)
9.6 (8.9-10.4)
14.2 (12.3-16.4)
9.9 (9.3-10.6)
7.0 (6.5-7.6)
12.2 (10.4-14.2)
13.4 (9.9-17.8)
- Complete data
observations
5.1 (4.5-5.8)
5.3 (4.7-6.0)
9.2 (7.4-11.4)
6.2 (5.6-6.9)
5.8 (5.2-6.5)
9.0 (6.9-11.8)
8.8 (5.9-13.0)
0.80 (0.61-0.90) Exclude GCS=3
transferred-in
7.7 (7.0-8.4)
9.0 (8.3-9.8)
13.7 (11.8-15.8)
9.3 (8.7-9.9)
6.7 (6.2-7.3)
12.3 (10.5-14.3)
12.6 (9.3-16.8)
0.99 (0.99-1.00) With adjustment for
comorbidities
9.0 (8.2-10.0)
10.2 (9.3-11.3)
- 10.5 (9.7-11.2)
7.0 (6.4-7.6)
13.0 (10.9-15.4)
- 0.94 (0.86-0.97)
Patients aged <85 years 7.1 (6.4-7.9)
8.9 (8.1-9.7)
12.6 (10.7-14.7)
9.1 (8.5-9.8)
6.1 (5.6-6.7)
11.3 (9.5-13.3)
12.3 (9.0-16.6)
0.99 (0.98-1.00) Patients presenting <48
hours following injury
8.5 (7.7-9.3)
10.6 (9.7-11.5)
14.7 (12.6-17.2)
11.0 (10.2-11.8)
7.5 (6.9-8.2)
13.6 (11.4-16.0)
14.0 (10.3-18.7)
0.98 (0.96-0.99) 30-day in-hospital
mortality
7.6 (6.9-8.4)
9.1 (8.4-9.9)
13.1 (11.3-15.3)
9.4 (8.7-10.0)
6.7 (6.2-7.3)
11.4 (9.7-13.3)
12.3 (9.0-16.5)
0.99 (0.98-1.00) Direct transport only 10.3
(9.3-11.3)
10.6 (9.6-11.6)
18.0 (14.3-22.4)
10.9 (10.1-11.7)
9.2 (8.4-10.0)
13.6 (10.9-16.7)
12.7 (8.7-18.4)
0.91 (0.82-0.96) Adjustment for potential
one-hour access to level I/II center
8.0 (7.3-8.8)
9.5 (8.8-10.3)
13.8 (11.9-15.9)
9.7 (9.1-10.4)
6.9 (6.4-7.5)
12.3 (10.5-14.3)
14.1 (10.6-18.7)
0.99 (0.99-1.00)
*Pearson’s correlation coefficient on Fisher-transformed proportions, weighted by hospital volume (95% confidence intervals)
