Citation

Schubert FD, Gabbe LJ, Bjurlin MA, Renson A. Injury 2019; 50(1): 186-191.

Affiliation

Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, USA. Electronic address: arenson@unc.edu.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.injury.2018.09.038

PMID

30266293

Abstract

BACKGROUND: Traumatic injury is a leading cause of deaths worldwide, and designated trauma centers are crucial to preventing these. In the US, trauma centers can be designated as level I-IV by states and/or the American College of Surgeons (ACS), reflecting the resources available for care. We examined whether state- and ACS-verified facilities of the same level (I-IV) had differences in mortality, complications, and disposition, and whether differences varied by center level.

MATERIALS AND METHODS: Using all admissions reported to the National Trauma Data Bank 2010-2015, we estimated risk ratios for the association between current ACS verification (vs. state designation) and patient mortality and complications, adjusting for trauma level and facility, injury, and demographic characteristics. We tested the interaction between trauma level and ACS verification, stratifying by trauma level in the presence of significant statistical interaction.

RESULTS: Overall, patients admitted to ACS-verified vs state-designated facilities had similar adjusted mortality risk [RR 1.00; 95% CI 0.91-1.03] and lower risk of discharge to intermediate care facilities [RR 0.58; 95% CI 0.44 to 0.78]. However, Level III and IV facilities had lower adjusted mortality risk when ACS-verified, with much lower mortality risk in ACS-verified Level IV facilities [RR 0.25; 95% CI 0.12 to 0.54].

DISCUSSION: Findings suggest that while outcomes are similar between ACS-verified and state-designated Level I and II centers, state-designated Level III and particularly Level IV centers show poorer outcomes relative to their ACS-verified counterparts. Further research could explore mechanisms for these differences, or inform potential changes to state designation processes for lower-level centers.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Health care management; Health policy; Quality improvement; Surgery; Trauma