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Are all trauma centers created equally? A statewide analysis.

Michael T Cudnik1, Michael R Sayre, Brian Hiestand

  • 1Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, USA. michael.cudnik@osumc.edu

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
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Mortality rates vary significantly among Level I trauma centers in Ohio, even for similar patients. Further research is needed to understand the causes of this variation in trauma care outcomes.

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Area of Science:

  • Trauma Surgery
  • Public Health
  • Health Services Research

Background:

  • Trauma center (TC) designation aims to standardize care for critically injured patients.
  • Previous studies indicate variations in mortality across different TC levels.
  • Limited data exist comparing outcomes between equivalently verified TCs.

Purpose of the Study:

  • To assess differences in mortality and discharge destinations among American College of Surgeons (ACS)-verified Level I TCs in Ohio.
  • To identify potential variations in patient outcomes despite similar injury severity and demographics.

Main Methods:

  • Retrospective analysis of a statewide trauma registry (2003-2006).
  • Included adult patients (>15 years) transferred from the scene to 10 Level I TCs (n=16,849).
  • Multivariable logistic regression models adjusted for patient/injury factors; calculated adjusted odds ratios (ORs) for mortality and discharge destination.

Main Results:

  • Significant variability in unadjusted mortality (3.8% to 24.2%) across Level I TCs.
  • Adjusted mortality also showed substantial variation, with ORs ranging from 0.93 to 6.02.
  • Similar variability observed in discharge destinations (home vs. rehabilitation/skilled nursing facility).

Conclusions:

  • Considerable variability exists in injured patient mortality across Ohio's Level I trauma centers.
  • These outcome disparities persist even after adjusting for patient and injury characteristics.
  • Further investigation into patient differences or care processes driving this variation is warranted.