A national evaluation of the effect of trauma-center care on mortality

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

Research output: Contribution to journalArticle

1532 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)366-378
Number of pages13
JournalNew England Journal of Medicine
Volume354
Issue number4
DOIs
StatePublished - Jan 26 2006
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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