Int J Burn Trauma 2011;1(1):56-61
Original Article
Evolution of a Level I Trauma System: changes in injury mechanism and its
impact in the delivery of care
Christy M. Lawson, A. Mariah Alexander, Brian J. Daley, Blaine L. Enderson
Department of Surgery, Division of Trauma and Critical Care, University of Tennessee Medical Center, Knoxville, Knoxville, TN,
USA.
Received July 11, 2011; accepted August 25, 2011; Epub September 3, 2011; published September 30, 2011
Abstract: 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.
(IJBT1107002).
Keywords: Trauma systems, Elderly, Falls, Trauma Mechanisms, Resource utilization
Address correspondence to:
Christy M. Lawson, MD
Department of Surgery
Division of Trauma/Critical Care
University of Tennessee Medical Center
Knoxville, Knoxville, TN, USA.
E-mail: cmlawson@utmck.edu
Original Article
Evolution of a Level I Trauma System: changes in injury mechanism and its
impact in the delivery of care
Christy M. Lawson, A. Mariah Alexander, Brian J. Daley, Blaine L. Enderson
Department of Surgery, Division of Trauma and Critical Care, University of Tennessee Medical Center, Knoxville, Knoxville, TN,
USA.
Received July 11, 2011; accepted August 25, 2011; Epub September 3, 2011; published September 30, 2011
Abstract: 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.
(IJBT1107002).
Keywords: Trauma systems, Elderly, Falls, Trauma Mechanisms, Resource utilization
Address correspondence to:
Christy M. Lawson, MD
Department of Surgery
Division of Trauma/Critical Care
University of Tennessee Medical Center
Knoxville, Knoxville, TN, USA.
E-mail: cmlawson@utmck.edu
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