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

1449 Citations (Scopus)

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

Fingerprint

Trauma Centers
Mortality
Wounds and Injuries
Confidence Intervals
Propensity Score
Diagnosis-Related Groups
Hospital Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

MacKenzie, E. J., Rivara, F. P., Jurkovich, G., Nathens, A. B., Frey, K. P., Egleston, B. L., ... Scharfstein, D. O. (2006). A national evaluation of the effect of trauma-center care on mortality. New England Journal of Medicine, 354(4), 366-378. https://doi.org/10.1056/NEJMsa052049

A national evaluation of the effect of trauma-center care on mortality. / MacKenzie, Ellen J.; Rivara, Frederick P.; Jurkovich, Gregory; Nathens, Avery B.; Frey, Katherine P.; Egleston, Brian L.; Salkever, David S.; Scharfstein, Daniel O.

In: New England Journal of Medicine, Vol. 354, No. 4, 26.01.2006, p. 366-378.

Research output: Contribution to journalArticle

MacKenzie, EJ, Rivara, FP, Jurkovich, G, Nathens, AB, Frey, KP, Egleston, BL, Salkever, DS & Scharfstein, DO 2006, 'A national evaluation of the effect of trauma-center care on mortality', New England Journal of Medicine, vol. 354, no. 4, pp. 366-378. https://doi.org/10.1056/NEJMsa052049
MacKenzie, Ellen J. ; Rivara, Frederick P. ; Jurkovich, Gregory ; Nathens, Avery B. ; Frey, Katherine P. ; Egleston, Brian L. ; Salkever, David S. ; Scharfstein, Daniel O. / A national evaluation of the effect of trauma-center care on mortality. In: New England Journal of Medicine. 2006 ; Vol. 354, No. 4. pp. 366-378.
@article{9bafa328c18a4b9eb4bf05bce99b8c77,
title = "A national evaluation of the effect of trauma-center care on mortality",
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.",
author = "MacKenzie, {Ellen J.} and Rivara, {Frederick P.} and Gregory Jurkovich and Nathens, {Avery B.} and Frey, {Katherine P.} and Egleston, {Brian L.} and Salkever, {David S.} and Scharfstein, {Daniel O.}",
year = "2006",
month = "1",
day = "26",
doi = "10.1056/NEJMsa052049",
language = "English (US)",
volume = "354",
pages = "366--378",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "4",

}

TY - JOUR

T1 - A national evaluation of the effect of trauma-center care on mortality

AU - MacKenzie, Ellen J.

AU - Rivara, Frederick P.

AU - Jurkovich, Gregory

AU - Nathens, Avery B.

AU - Frey, Katherine P.

AU - Egleston, Brian L.

AU - Salkever, David S.

AU - Scharfstein, Daniel O.

PY - 2006/1/26

Y1 - 2006/1/26

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=31344470705&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=31344470705&partnerID=8YFLogxK

U2 - 10.1056/NEJMsa052049

DO - 10.1056/NEJMsa052049

M3 - Article

C2 - 16436768

AN - SCOPUS:31344470705

VL - 354

SP - 366

EP - 378

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 4

ER -