13. Effect Of Trauma Center Designation (Level I or II) and Trauma Volume On Outcomes In Critically Injured Patients
Demetrios Demetriades, MD, PhD, Mathew Martin, MD*, Ali Salim, MD*, Peter Rhee, MD*, Carlos Brown, MD*, Linda Chan, PhD*
University of Southern California, LA, CA
Objectives: To investigate the effect of ACS trauma center designation and trauma volume on outcome in patients with specific severe injuries.
Methods: National Trauma Data Bank study which included patients >14 years of age, had Injury Severity Score (ISS) >15, were alive on admission and had at least one of the following severe injuries: Aortic, vena cava, iliac vessels, cardiac, grade IV/V liver injuries, quadriplegia or complex pelvic fractures. Outcomes (mortality, ICU stay and severe disability at discharge) were compared among level I and II trauma centers and between centers within the same level designation but different volumes of severe trauma (<240 vs >240 trauma admissions with ISS>15 per year). The outcomes were adjusted for age (<65 and =>65), gender, mechanism, hypotension on admission, head injury (head AIS=<3 and >3) and ISS (=<25 and >25).
Results: 8,341 patients met the inclusion criteria. Level I centers had significantly lower mortality [25.3% vs 29.3%, adjusted OR (95% CI), 0.81 (0.71, 0.94) p=0.004] and significantly lower severe disability at discharge [20.3% vs 33.8%, adjusted OR (95% CI), 0.55 (0.44, 0.69), p<0.001] than level II centers. The volume of trauma admissions with ISS>15 (<240 vs >=240 cases per year) had no effect on outcome.
Conclusions: Level I trauma centers have better outcomes in critical injuries than lower level centers. The volume of major trauma admissions does not influence outcome, in either level I or II centers