Evaluating an inclusive trauma system using linked population-based data

Background: Federal and professional programs require "inclusive" trauma systems. We wished to evaluate an inclusive trauma system using administrative data combined from multiple sources. Methods: Ambulance reports, outpatient/inpatient discharge data, and/or death certificates were obtained for persons with injury diagnoses who received hospital services and/or died in Maine during 1998 to 2000. Records were unduplicated and joined using probabilistic record-linkage software. Case outcomes, determined from one or more linked records, included place of hospitalization, discharge status, and 30-day mortality. Results: Per 100,000 population annually, 11,100 injured persons were treated and released, 573 were admitted, and 51.3 died. Trauma centers received 37.0% of major cases directly and another 15.4% in transfer; 51.4% of injury deaths occurred without medical intervention, 21.2% occurred in trauma centers, 20.4% occurred in other hospitals, and 7.0% occurred after discharge from a hospital. Database queries produced comparative hospital statistics and identification of questionable outcomes. Conclusion: Record linkage allows inexpensive description of an inclusive trauma system and may contribute to quality improvement.