STANDARDIZED MORTALITY RATIO ANALYSIS ON A SAMPLE OF SEVERELY INJURED PATIENTS FROM A LARGE CANADIAN CITY WITHOUT REGIONALIZED TRAUMA CARE

Flora's Z statistic and standardized mortality ratios (SMRs) as indicators of excess mortality were calculated for a sample of 355 patients with major trauma. A statistically significant overall excess mortality was observed in this sample (Z = 6.77, SMR = 1.81, p < 0.05). Advanced life support provided by physicians at the scene (MD-ALS) was not associated with reduced excess mortality. A significant trend toward lower excess mortality was associated with a higher level of trauma care at the receiving hospital (p < 0.05). Total prehospital time over 60 minutes was associated with a significant increase in excess mortality (p < 0.001). These results support regionalization of trauma care and failed to show any benefit associated with MD-ALS.