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Medical Care Research and Review, Vol. 64, No. 1, 83-97 (2007)
DOI: 10.1177/1077558706296241

Survival Advantage Associated with Treatment of Injury at Designated Trauma Centers

A Bivariate Probit Model with Instrumental Variables

Etienne E. Pracht

University of Florida

Joseph J. Tepas, III

University of Florida

Brian G. Celso

University of Florida

Barbara Langland-Orban

University of South Florida

Lewis Flint

University of South Florida

This article analyzes the effectiveness of designated trauma centers in Florida concerning reduction in the mortality risk of severely injured trauma victims. A bivariate probit model is used to compute the differential impact of two alternative acute care treatment sites. The alternative sites are defined as (1) a nontrauma center (NC) or (2) a designated trauma center (DTC). An instrumental-variables method was used to adjust for prehospital selection bias in addition to the influence of age, gender, race, risk of mortality, and type of injury. Treatment at a DTC was associated with a reduction of 0.13 in the probability of mortality.

Key Words: trauma • trauma systems • effectiveness • instrumental variables


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