Receiving care facility and outcome differences for victims of severe violent injuries

Each year millions of people die resulting from violence. Our objective was to evaluate and describe the demographic characteristics, access to trauma center care, mortality and morbidity outcomes of victims of severe violence in Pennsylvania.

This was a cross-sectional population-based observational study. ICD-9-CM diagnostic codes were utilized to define acute injuries; severe injury was defined by an Injury Severity Score (ISS) greater than 15. Descriptive statistics and confidence intervals were used to present group characteristics. For categorical variables, chi-square testing and Fisher's exact testing were used to assess associations, and the Odds Ratio was used as the measure of strength of association. For all tests statistical significance was set at the 0.05 level.

A total of 8,977 patients with ISS > 15 were included; out of which 663 cases resulted from violence. Three hundred and forty seven (52.3%) were admitted to non-trauma center hospitals (NTC); Three hundred-and-sixteen (47.7%) to trauma center hospitals (TC). Mean length of stay and the rate of complications were significantly greater in the NTC facilities (p = 0.001 and 0.003, respectively) and a higher but statistically nonsignificant mortality increase was found in non-trauma centers (10.4% vs. 15.2%).

Despite statewide EMS and trauma care systems, half of severely injured victims of violence were cared for in NTC facilities. TC hospitals showed a small but significant outcomes benefit in terms of complications and lengths of stay.