The effect of a trauma system on the outcome of patients with pancreatic trauma

G. R. Voeller, E. C. Mangiante and T. C. Fabian
Department of Surgery, University of Tennessee, Memphis 38163.

Patients suffering pancreatic trauma before and after the creation of a regional trauma center were analyzed. Between 1975 and 1982, before the trauma system was established, 80 patients (10 per year) with pancreatic injury were treated. From 1984 to 1987 (after trauma system implementation), 58 patients (19 per year) with pancreatic injury were treated. There were no significant differences in demographics, mechanisms of injury, types of pancreatic wound, or associated injuries. Sixteen (20%) patients with pancreatic injury during the study period died before the trauma center was established. Of these, 13 (81%) died of hemorrhage. In contrast, five (9%) patients with pancreatic injury who were treated after the trauma center was operational died. Only one death was due to hemorrhage. By relative risk, a patient was 2.67 times more likely to die and 17 times more likely to die of hemorrhage before the presence of the trauma center than after (P less than .03). In this study of a patient population suffering severe intra-abdominal injuries, Organ Injury Outcome Analysis demonstrates that development of a trauma system significantly improves outcome.