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Does the Halo Effect for Level 1 Trauma Centers Apply to High-Acuity Nonsurgical Admissions?

Ann E Hwalek, Anai N Kothari, Elizabeth H Wood

    The Journal of the American Osteopathic Association
    |April 28, 2020
    PubMed

    Insights

    Level 1 trauma centers did not show improved survival rates for high-acuity medical conditions like heart attack, heart failure, or pneumonia compared to other hospitals. This study found no mortality benefit for these nonsurgical diagnoses.

    Area of Science:

    • Healthcare outcomes research
    • Trauma center efficacy
    • Hospital quality metrics

    Background:

    • The halo effect suggests trauma centers improve outcomes for non-trauma cases.
    • This phenomenon warrants investigation for common, high-acuity medical conditions.

    Purpose of the Study:

    • To assess if Level 1 trauma centers reduce inpatient mortality for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA).
    • Comparison between Level 1 trauma centers and non-Level 1 trauma centers for these medical diagnoses.

    Main Methods:

    • Population-based, retrospective cohort study using Healthcare Cost and Utilization Project and AHA data (2006-2011).
    • Inclusion of patients with AMI, CHF, and PNA in Florida and California.
    • Propensity score matching to compare Level 1 trauma centers with non-Level 1 trauma centers.
    • Primary outcome: risk-adjusted inpatient mortality.

    Main Results:

    • Analysis included 190,474 patients; 49% treated at Level 1 trauma centers.
    • No significant difference in mortality for AMI (8.10% vs 8.40%, P=.73).
    • No significant difference in mortality for CHF (2.26% vs 2.71%, P=.90).
    • No significant difference in mortality for PNA (2.30% vs 2.70%, P=.25).

    Conclusions:

    • Level 1 trauma center designation was not associated with reduced inpatient mortality for high-acuity, nonsurgical conditions.
    • Findings challenge the broad applicability of the halo effect to medical admissions at trauma centers.
    Abstract

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