Level I Trauma Centers Have Varying Patient Survival Rates

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Article Date: 23 Feb 2008 - 0:00 PDT

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Level I trauma centers may have very different results when treating patients, even when they have similar injuries. This was analyzed in a report on February 18, 2008 in the Archives of Surgery, one of the JAMA/Archives journals.

Trauma centers have been established in most states, thanks to years of dedicated efforts by professionals in the field and patient advocacy groups. These centers have explicit criteria concerning personnel, equipment, and services, which are verified by the American College of Surgeons (ACS.) These criteria were conceived based on structures and processes that are considered necessary for providing the best care.

Shahid Shafi, M.D., M.P.H., and colleagues at the University of Texas Southwestern Medical School, Dallas, compared data from 211,479 patients checked into 47 level I trauma centers between 1999 and 2003. Patients were classified into three different groups depending on the seriousness of their injuries, which was assessed by several means including blood pressure and shock. The percentage of surviving patients was calculated for all centers, and the surviving percent was compared to this average.

For patients with mild injuries, 99 percent survived. In contrast, 75 percent of those with moderate injuries survived, and 35 percent of those with severe injuries died. "For mild injuries, survival at five centers (11 percent) was significantly worse than that at their counterpart centers," the authors write. "With increasing injury severity, the percentages of outcome disparities increased (15 percent of centers for moderate injuries and 21 percent of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries and older (more than 55 years) individuals."

The authors continue with a summary of the implications of the results. "These variations in outcomes may represent a substantial quality chasm in the delivery of trauma care." They indicate that one weakness in the verification process could be that the resources necessary for a trauma center are not broad enough. When these essential resources are missing, this can result in sub-optimal care. For instance, a previous study indicated that that a trauma and surgical critical care fellowship program generally improved outcomes at level I trauma centers, but this is not required for validation as a center.

Also, the presence of the necessary resources does not guarantee that they will be used enough. The authors conclude: "If confirmed, our preliminary data suggest that the logical next step for the trauma community is to move beyond focusing on personnel and processes and to start focusing on the outcomes achieved by the use of those resources."

Moving Beyond Personnel and Process: A Case for Incorporating Outcome Measures in the Trauma Center Designation Process
Shahid Shafi, MD, MPH; Randall Friese, MD; Larry M. Gentilello, MD
Arch Surg. 2008;143[2]:115-119
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Written by Anna Sophia McKenney
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