Status of trauma care in U.S. Army hospitals.

OBJECTIVE This study documents the recent trends and current state of inpatient trauma care in U.S. Army hospitals. METHODS Inpatient trauma cases from Army hospitals worldwide from October 1988 through April 2001 were analyzed. Facilities included 3 Certified Trauma Centers (CTCs), 7 non-CTC Army Medical Centers, and 42 Army Community Hospitals. Logistic regression identified mortality risk factors. RESULTS Overall, the Army treated 166,124 trauma cases, with a mortality rate of 0.8% (trend of 0.66% to 1.18% in fiscal years 1989-2000, p < 0.0001). The number of Army hospitals decreased by 44% and the number of trauma cases decreased by nearly 75%. Injury severity, patient age, hospital trauma volume, beneficiary category, hospital type, and a resource intensity measure were all significantly associated with the probability of death. CONCLUSIONS The overall trauma mortality rate at Army hospitals during the study period was lower than that reported for civilian trauma centers. However, changes in patient profiles, increased average severity, and decreased trauma volume might have contributed to a 13% increase in mortality rates at CTCs.