Mortality Factors in Major Trauma Patients: Nation-wide Population-based Research in Taiwan

Background: Major trauma remains a significant medical concern, leading to about 10,000 deaths annually in Taiwan. Trauma system implementation has been shown to improve the outcomes in different countries. Using the National Health Insurance data, our study examined the influence of age and other factors on the outcomes of trauma patients. Materials and methods: We collected the original claim data of 1 million beneficiaries who enrolled in the National Health Insurance program from 2006 to 2008. ICDMAP-90 was used for calculating the Injury Severity Score (ISS), which was required for assessing the disease severity and implementing appropriate control measures. Other variables included age, sex, triage classifications, pre-existing comorbidities, and hospital levels. The Charlson Comorbidity Index for the year of admission was used for adjusting comorbid conditions. Results: A total of 2497 major trauma patients (ISS >15) were identified in our database. After controlling all the variables in a logistic regression model, for all the major trauma patients, a significant difference was observed between different hospital levels. Compared with the trauma centers, the risk of mortality in nontrauma centers was 1.58 times that in trauma centers (p = 0.004). In the younger groups (aged <40 and 41–60 years), hospital levels had no significant effect on mortality (p = 0.40, 0.41). However, the risk of mortality was 1.89 times in nontrauma centers, compared to that in trauma centers, in the oldest group (p = 0.005). Conclusion: Our study suggests that all major trauma patients should be sent to trauma centers, especially the older patients.