Differences in trauma mortality between ACS-verified and state-designated trauma centers in the US.

Databases, Factual / statistics & numerical data Hospital Mortality / trends Humans Injury Severity Score Odds Ratio Outcome Assessment, Health Care Societies, Medical Trauma Centers / standards United States Wounds and Injuries / mortality
Health care management Health policy Quality improvement Surgery Trauma

Journal

Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040

Informations de publication

Date de publication:
Jan 2019
Historique:
received: 20 03 2018
revised: 31 08 2018
accepted: 19 09 2018
pubmed: 30 9 2018
medline: 24 5 2019
entrez: 30 9 2018
Statut: ppublish

Résumé

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. 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. 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]. 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1016/j.injury.2018.09.038 PMID: 30266293
pubmed: 30266293
pii: S0020-1383(18)30542-4
doi: 10.1016/j.injury.2018.09.038
pii:
doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

186-191

Informations de copyright

Copyright © 2018 Elsevier Ltd. All rights reserved.

Auteurs

Finn D Schubert (FD)

Department of Clinical Research, New York University Langone Hospital-Brooklyn, Brooklyn, NY, USA.

Laura J Gabbe (LJ)

Department of Clinical Research, New York University Langone Hospital-Brooklyn, Brooklyn, NY, USA.

Marc A Bjurlin (MA)

Department of Urology, New York University Langone Hospital-Brooklyn, Brooklyn, NY, USA.

Audrey Renson (A)

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

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Classifications MeSH

questionsmedicales.fr › Sciences de l'information › Mémorisation et recherche des informations › Bases de données comme sujet › Bases de données factuelles › Differences in trauma mortality between...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › Differences in trauma mortality between...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Differences in trauma mortality between...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Score de gravité des lésions traumatiques › Differences in trauma mortality between...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Odds ratio › Differences in trauma mortality between...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Differences in trauma mortality between...
questionsmedicales.fr › Organisations et économie des soins de santé › Organismes › Sociétés › Sociétés médicales › Differences in trauma mortality between...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Centres de traumatologie › Differences in trauma mortality between...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › États-Unis › Differences in trauma mortality between...
questionsmedicales.fr › Plaies et blessures › Differences in trauma mortality between...