TITLE

A National Evaluation of the Effect of Trauma-Center Care on Mortality

AUTHOR(S)

MacKenzie, Ellen J.; Rivara, Frederick P.; Jurkovich, Gregory J.; Nathens, Avery B.; Frey, Katherine P.; Egleston, Brian L.; Salkever, David S.; Scharfstein, Daniel O.

PUB. DATE

January 2006

SOURCE

New England Journal of Medicine;1/26/2006, Vol. 354 Issue 4, p366

SOURCE TYPE

Academic Journal

DOC. TYPE

Article

ABSTRACT

Background: Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non–trauma centers). Methods: Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non–trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non–trauma centers. Results: After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non–trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries. Conclusions: Our findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non–trauma center and argue for continued efforts at regionalization. N Engl J Med 2006;354:366-78.

ACCESSION #

24929907

Tags: TRAUMA centers;  HOSPITALS -- Emergency services;  OUTCOME assessment (Medical care);  MEDICAL care -- Evaluation;  MORTALITY;  EMERGENCY medical services

 

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