A multi-center retrospective study on the effect of the establishment of the three-level trauma emergency center system on the success rate of patients with severe multiple injuries in Jiangxi Province, China
Authors: zeng yuanlin , chen haiming , zhou qiangping 
Published: May 2023

Abstract
Background:The incidence of trauma has increased year by year, which has become one of the most common causes of death, however, different regions and countries adopt different modes of treatment. The purpose of this study was to explore the effect of the establishment of a graded trauma emergency system on the success rate of treatment for patients with severe multiple injuries in Jiangxi Province, China, which is mountainous and geographically extensive.
Methods: A retrospective multi-center case-control study was used to analyze the effect of the three-level trauma emergency center system on the success rate of severe multiple injuries in Jiangxi Province, China. The study subjects were 1834 patients with severe multiple injuries admitted before and after the establishment of 9 Jiangxi provincial level 1 trauma emergency centers from January 2016 to June 2022, 1588 patients with severe multiple injuries admitted before and after the establishment of 15 Jiangxi provincial level 2 trauma emergency centers from November 2018 to June 2022, and 3044 patients with severe multiple injuries admitted before and after the establishment of 47 Jiangxi provincial level 3 trauma emergency centers from September 2018 to August 2022. The patients admitted after the establishment of Jiangxi Provincial trauma emergency center were taken as the study group, and the patients admitted before the establishment of Jiangxi Provincial trauma emergency center were taken as the control group. The general information, ISS (Injury sever score),
the time from visiting to completing computed tomography (CT) examination, the time from the issuance of a blood transfusion application f to the start of blood transfusion (the preparation time for emergency blood transfusion) , the time from visiting to enter the operating room for patients who required emergency surgery, the length of stay in ICU, the length of stay in hospitaland prognosis were compared between the two groups. Mann-Whitney U tests were used for non-parametric continuous data, and the chi-square test was used to compare the counting data.
Results: There was no significant difference in gender, age, ISS score and the mechanism of injury between the research group and the control group in different levels trauma emergency centers (P> 0.05). In the level 1 trauma emergency center, compared with the control group, the time from visiting to complete CT examination (P=0.001) and the preparation time for emergency blood transfusion (P=0.003) were markedly shortened in the research group, as well as the time from visiting to the operating room (P=0.008). However, the cure success rate of the research group was increased significantly than that in the control group (83.60% vs 68.66%, P< 0.001). In line with this, in the level 2 trauma emergency center, compared with the control group, the above three kinds of time are significantly shortened than that in the research group (P<0.01), but the cure success rate of the research group was higher significantly (67.76% vs 62.50%, P=0.029). However, in the level 3 trauma emergency center, there was no statistical difference in the time from visiting to completion of CT examination between the two groups (P=0.529), while the preparation time for emergency blood transfusion (P< 0.001) was obviously shortened in the research group, as was the time from visiting to the operating room (P< 0.001), the cure success rate was higher significantly than the control group (61.97% vs 57.98%, P=0.027). In addition, we found that after the establishment of the trauma emergency center, the higher the level of trauma emergency centers, the higher the cure success rate for patients with severe multiple，which was 83.60%，67.76%，61.97% in level 1, level 2 and level 3 trauma emergency center，respectively。
Conclusions: In Jiangxi Province, China, with its extensive and mountainous terrain, its three-level trauma emergency center system can significantly shorten the first time of rescue, improve the treatment efficiency in hospital, and thus achieve the improvement of the success rate of treatment for patients of severe multiple injuries.