Effectiveness of Integrated Trauma System Implementation on Road Traffic Fatalities and Injuries in the North of Iran Using an Interrupted Time Series Analysis

TL;DR

This study shows that implementing an integrated trauma system in Guilan, Iran, significantly reduced road traffic crashes, injuries, and deaths compared to a neighboring province without such a system.

Contribution

The study provides empirical evidence of the effectiveness of integrated trauma systems in reducing road traffic fatalities and injuries in Iran.

Findings

Guilan's daily road traffic crashes decreased significantly after ITS implementation, while the control province saw an increase.

Mortality rates in Guilan declined marginally, whereas they rose sharply in the control province.

Statistical analysis confirmed a significant reduction in injuries and deaths in Guilan post-intervention.

Abstract

Background: Integrated trauma systems (ITS) have shown potential in reducing traffic crash-related injuries and mortality, although their structure and impact can vary. This study assessed the effectiveness of ITS in Guilan, Iran.

Study Design: A retrospective observational study.

Methods: Utilizing a cross-sectional analysis, this descriptive-analytical study was conducted in Northern Iran from 2015 to 2019 to compare road traffic crash (RTC) data in Guilan (with ITS) against Mazandaran (without ITS), considering weather as a confounder. The study involved pre- and post-ITS intervention analyses to evaluate changes in RTC, injury, and mortality rates.

Results: Before ITS implementation, Guilan’s daily RTC mean was 38.4 (SD=16.7), which significantly decreased to 30.8 (SD=13.7) after the intervention. Conversely, in the control province of Mazandaran, the daily average number of RTCs increased from 37.29 (SD=14.1) to 42.55 (SD=16.4) post-ITS implementation in Guilan. Furthermore, the mortality rate in Guilan showed a marginal decline from 27.74 (SD=12.6) pre-ITS to 26.60 (SD=11.9) post-ITS, indicating the positive impact of the ITS. In contrast, Mazandaran demonstrated a significant increase in mortality from 32.16 (SD=14.5) to 51.75 (SD=15.7). The statistical analysis confirmed a significant reduction in mortality and injury incidence in Guilan at the time of the intervention, with a marked decrease observed post-intervention (P<0.001).

Conclusion: The findings revealed that RTC prevention is feasible in Iran, with ITS in Guilan significantly reducing RTCs, injuries, and mortalities, underscoring the importance of ongoing efforts to expand ITS components nationally.

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