Citation

Haas B, Gómez D, Neal ML, Hoeft C, Ahmed N, Nathens AB. Ann. Surg. 2011; 253(5): 992-995.

Affiliation

Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. National Trauma Databank, Chicago, Illinois.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/SLA.0b013e3182122346

PMID

21368656

Abstract

OBJECTIVE:: In this study, we sought to determine whether the proximity of a level 1 trauma center (TC) might affect the performance of a nearby level 2 TC. BACKGROUND:: With the exception of research and teaching programs, level 2 TC must function at a level similar to that of level 1 TC, and provide high quality, definitive care to severely injured patients. However, the role of a level 2 TC within a region might vary significantly depending on the local trauma care environment. We postulated that the case mix, regional role and outcomes of level 2 TC are greatly influenced by the regional presence of a level 1 TC. METHODS:: Data were derived from the National Trauma Databank (9.0), limiting to adults with Injury Severity Score ≥9. Level 2 TC were classified as either isolated trauma centers (ITC, >30 miles from the closest level 1 TC) or neighbored trauma centers (NTC, ≤30 miles from the closest level 1 TC). Regression was used to calculate risk-adjusted mortality at each center type. RESULTS:: Fifty-five thousand six hundred and fifty-five patients were identified at 161 centers; 55% of patients were cared for at ITC (n = 84 centers). Case mix varied significantly across center type; in particular, ITC received significantly more transfer patients than NTC. After adjusting for differences in case mix, patients at ITC had a 12% lower risk of death than patients treated at NTC (0.88, 95% CI 0.78-0.98). CONCLUSIONS:: Level 2 TC assume different roles depending on the local trauma system configuration. Ideally, a level 2 TC should benefit from the presence of a nearby level 1 TC through collaborations in care protocols and shared case reviews. However, these data suggest the opposite: level 2 centers in proximity to level 1 centers might perform at a lower than expected level.

Language: en