Trauma levels and survival

Jan 27, 2008
Change in Trauma Level Designation Associated With Improved
Patient Survival

Death rates among patients admitted to a Colorado trauma
center appeared to decrease after the center’s designation
was upgraded, according to a report in the January issue of
Archives of Surgery, one of the JAMA/Archives journals.

Trauma centers are accredited through the American College
of Surgeons, according to background information in the
article. Level designations are based on factors such as
surgeon and nurse availability, protocols and research.
Level 1 is the highest level of trauma center and most
studies report improvements in survival and outcomes for
patients admitted to these centers as compared with
lower-level centers and non-trauma centers, although some
have found no difference between level 1 and level 2
centers.

The trauma center at Swedish Medical Center —a community
hospital in Englewood , Colo. —was upgraded from level 2 to
level 1 in 2002. Kristin Scarborough, B.S., and colleagues
at the hospital studied all 17,413 trauma patients
consecutively admitted to the trauma center between 1998
and 2007. The researchers compared death rates of the 9,511
patients admitted when the center was designated level 2
(Jan. 1, 1998, to Dec. 31, 2002) to those of the 7,902
patients admitted after the upgrade to level 1 (Jan. 1,
2003, to March 31, 2007).

After adjusting for several other factors—including age,
sex, injury severity, low blood pressure on hospital
admission, breathing rate and co-occurring illnesses—3.48
percent of patients admitted during level 2 designation
died, compared with 2.5 percent of those admitted during
level 1 designation. Among severely injured patients, 14.11
percent of those admitted during the level 2 designation
died, compared with 8.99 percent of those admitted during
level 1 designation.

“Patients admitted during a level 1 designation with a
severe head, chest or abdominal or pelvic injury diagnosis
had a significant decrease in mortality [death] (9.96
percent vs. 14.51 percent, 7.14 percent vs. 11.27 percent,
and 6.76 percent vs. 17.05 percent, respectively), as did
patients who developed acute respiratory distress syndrome
during their hospital stay (9.51 percent vs. 26.87
percent),” the authors write.

The results suggest that modifying protocols to send trauma
patients to the appropriate trauma facility may improve
survival, the authors note. “The number of patients needed
to be treated at a level 1 trauma center over a level 2
trauma center to save one life is as follows: overall, 70
patients; injury severity score of 15 or more [severely
injured], 22 patients; head injury, 17 patients; chest
injury, 20 patients; and abdominal or pelvic injury, eight
patients,” they write. “In addition, every fourth patient
who developed acute respiratory distress syndrome may have
been saved had the patient been triaged to a level 1 trauma
center.”

Arch Surg. 2008; 143[1]:22-28.