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A secondary objective was to compare access to level I/II trauma centres across age groups. This was an observational study based on prospectively collected data abstracted from patient files for a clinical registry. The study was based on patients with a primary diagnosis of injury (International Classification of Diseases code 800-959; excluding late effects, foreign bodies, complications and burns) admitted to any of the 57 adult trauma centres of the Quebec trauma system between 1999 and 2006. Inclusion criteria were as follows: death following injury, intensive care unit admission, hospital stay >2 days, or transfer from another hospital. The [http://www.selleckchem.com/products/at13387.html Onalespib ic50] following exclusion criteria were applied: [http://www.selleckchem.com/erk.html ERK inhibitor] study period, the system included 6 level I (including 2 paediatric), 4 level II, 21 level III, and 28 level IV centres. Standardised pre-hospital protocols ensure that major trauma cases are taken to these hospitals and standing agreements regulate inter-hospital transfers within the system by ambulance or airplane. The distance between any hospital and the nearest level I trauma centre ranges between 50?km (35 miles) and 1600?km (1000 miles). The population of Quebec is 7.5 million. Data was drawn from the Quebec Trauma Registry, which is mandatory for all 59 designated provincial trauma centres. The registry is centralised at the Quebec Ministry of Health and is subject to periodic validation to identify and correct aberrant data values in all data fields and to verify date chronology. Registry data are extracted from patient files by medical archivists [http://en.wikipedia.org/wiki/Cisplatin Cisplatin] who use standardised coding protocols. Supervision by a data coordinator, yearly on-going training, an electronic forum of coding queries, and thrice-yearly meetings with key stakeholders (e.g. trauma physicians, researchers, administrators) all help to improve inter-rater reliability. If patients were entered twice for the same injury due to transfer, only information from the definitive treatment hospital was retained. The Quebec Trauma Registry contains anatomical injury codes, indicators of physiological response to injury, and patient demographics. Anatomic injury is described with the Abbreviated Injury Scale (AIS-90) according to Association for the Advancement of Automotive Medicine guidelines.