When a Colorado trauma center’s designation was upgraded death rates among patients appeared to fall, says an article in Archives of Surgery (JAMA/Archives), January issue.

The authors explain that trauma centers are accredited through the American College of Surgeons (ACS). Such factors as nurse/surgeon availability, protocols and research decide level designations, with Level 1 being the highest level of trauma center. According to most studies, patients admitted to Level 1 trauma centers have better outcomes and survival rates that those admitted to lower-level centers and non-trauma centers. Some studies have found no difference in such rates among Levels 1 and 2 trauma centers.

In 2002, the Swedish Medical Center, Englewood, Colorado, USA, was upgraded from Level 2 to 1.

Kristin Scarborough, B.S., from the Swedish Medical Center, and team looked at 17,413 trauma patients who had been consecutively admitted to the center during 1998-2007. 9,511 had been admitted prior to upgrading of the center, while 7,902 were admitted after the upgrading to Level 1.

Taking into account such variables as age, sex, severity of injury, low blood pressure at the time of admission, breathing rate and co-occurring illnesses, the researchers found that –

— 3.48% of patients before upgrading died
— 2.5% of patients after upgrading died
— 14.11% of severely injured patients before upgrading died
— 8.99% of severely injured patients before upgrading died

The researchers wrote “Patients admitted during a level 1 designation with a severe head, chest or abdominal or pelvic injury diagnosis had a significant decrease in mortality [death] (9.96 percent vs. 14.51 percent, 7.14 percent vs. 11.27 percent, and 6.76 percent vs. 17.05 percent, respectively), as did patients who developed acute respiratory distress syndrome during their hospital stay (9.51 percent vs. 26.87 percent).”

“The number of patients needed to be treated at a level 1 trauma center over a level 2 trauma center to save one life is as follows: overall, 70 patients; injury severity score of 15 or more [severely injured], 22 patients; head injury, 17 patients; chest injury, 20 patients; and abdominal or pelvic injury, eight patients. In addition, every fourth patient who developed acute respiratory distress syndrome may have been saved had the patient been triaged to a level 1 trauma center.”

“Reduced Mortality at a Community Hospital Trauma Center The Impact of Changing Trauma Level Designation From II to I”
Kristin Scarborough, BS; Denetta Sue Slone, MD; Phyllis Uribe, RN; Michael Craun, MD; Raphael Bar-Or, BS; David Bar-Or, MD
Arch Surg. 2008;143(1):22-27.
Click here to view abstract online

Written by – Christian Nordqvist