Statewide Discharge Data Supports Development of Inclusive Trauma System

Area of Science:

• Trauma care research
• Health services research
• Injury epidemiology

Background:

• Trauma center verification and state designation are linked to better patient outcomes.
• Optional participation in trauma systems necessitates evidence of outcome disparities for legislative action.
• Accurate risk adjustment is crucial for comparing outcomes between trauma and non-trauma centers, with the International Classification of Diseases, 10th Revision injury severity score (ICISS) being a validated tool.

Purpose of the Study:

• To compare outcomes between trauma centers and non-trauma centers using validated risk adjustment.
• To identify specific patient groups and injury types predominantly treated at trauma centers.
• To evaluate the impact of trauma center care on mortality and specific morbidities.

Main Methods:

• Analysis of state Healthcare Cost and Utilization Project data from 2018-2020.
• Utilized the International Classification of Diseases, 10th Revision injury severity score (ICISS) for risk adjustment.
• Compared outcomes across overall, age-specific, and diagnosis-specific patient cohorts.

Main Results:

• Trauma center patients exhibited lower risk-adjusted mortality, acute kidney injury, and pulmonary embolism rates.
• Higher rates of ventilator-associated pneumonia and surgical site infections were observed in trauma centers.
• Pediatric patients and those with traumatic brain injuries or shock were more frequently treated at trauma centers.
• Older age, higher injury severity, male gender, and non-trauma center treatment correlated with decreased survival.
• Geriatric patients with proximal femur fractures treated at non-trauma centers showed no mortality benefit from trauma center care.

Conclusions:

• Trauma center care is associated with improved patient outcomes, supporting the expansion of trauma systems.
• Risk-adjusted comparisons highlight benefits in mortality and specific complications, but also identify areas for improvement.
• Subgroup analyses underscore the importance of specialized care for vulnerable populations within trauma systems.