03 Jun Severely Injured Patients Do Better In High Level Trauma Centers
Medical Research: What is the background for this study? What are the main findings?
Response: In the United States trauma system, the most severe injuries ideally should receive definitive treatment at level I or level II trauma centers, while less severe injuries should receive treatment at level III or nontrauma centers. “Undertriage” occurs when a severe injury receives definitive treatment at a lower level trauma center instead of a level I or level II trauma center. But no study had used nationally representative data to evaluate mortality outcomes of undertriage at nontrauma centers.
Our study found detrimental consequences associated with undertriage at nontrauma centers. There was a significant reduction in the odds of emergency department (ED) death – by approximately half – in severely injured trauma patients who were properly triaged to a level I or level II trauma center versus those who were undertriaged to a nontrauma center. We also found that patients with moderate injuries may not have a reduction in the odds of ED death when triaged to a level I or level II trauma center instead of a nontrauma center. That suggests a possible threshold of injury severity when triaging trauma patients.
Medical Research: What should clinicians and patients take away from your report?
Response: It is critically important that a severely injured trauma patient be properly triaged to a level I or level II trauma center. There is proof that odds of ED mortality decrease substantially when that happens. Improving triage protocols, accommodating additional trauma victims at high level trauma centers and/or improving the response of nontrauma centers to major trauma may produce better outcomes.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: A previous study found that level I and level II trauma centers would have to expand major trauma capacity by more than 51% to accommodate all trauma patients with moderate to severe trauma. That is likely not feasible. Those high level trauma centers would only have to expand severe trauma capacity by 6.2%, however, to accommodate all trauma patients with severe trauma. The feasibility of that increase should be studied further.
Comparative Study of ED Mortality Risk of US Trauma Patients Treated at Level I & Level II vs. Nontrauma Centers
Vickers, Brian P. et al.
The American Journal of Emergency Medicine Published Online: May 15, 2015
Huiyun Xiang, M.D., M.P.H. Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, & Columbus, OH (2015). Severely Injured Patients Do Better In High Level Trauma Centers MedicalResearch.com
Last Updated on June 4, 2015 by Marie Benz MD FAAD