'The Demographics of Trauma in 1995' revisited: An assessment of the accuracy and utility of trauma predictions

Objective: In 1987, the article 'The Demographics of Trauma in 1995' (DT95) attempted to predict the future needs of trauma centers based on changing population distributions. This article foresaw a relative increase in the number of injuries to the elderly and a relative decrease in total injuries. Based on these predictions, the paper recommended increasing the capabilities of existing trauma centers rather than developing new facilities. We compared these predictions to actual experience to validate this use of demographic data in trauma system planning. Methods: The predictions of DT95 were compared with the available population and injury data from the U.S. Census Bureau and the Centers for Disease Control and Prevention using age-related cohort analysis. Results: As predicted, the highest-growing segment was the population older than 65 years, which increased 18% to 33.5 million. Also, the rate of injury-related deaths per 100,000 decreased from 61.20 in 1985 to 57.98 in 1995. The number of fatal motor vehicle crashes decreased from 45,958 in 1985 to 43,484 in 1995. Against predictions, the number of firearm deaths in 1994 increased from 31,566 to 35,957. Accurate predictions were thus made for most trauma demographic categories using a combination of census predictions and existing trauma demographic patterns. The increase in firearm deaths, however, was not anticipated using these sources and suggested the potential development of a more violent society. Conclusions: Demographic projections assist in predicting the number and type of future injuries. Sociologic and economic factors also need to be considered in any predictive determinations of the true demand for trauma centers.