Dakessian A, Bachir R, El Sayed MJ. J. Emerg. Med. 2020; ePub(ePub): ePub.
Affiliation
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
BACKGROUND: Motor vehicular transport (MVT) is a leading cause of injuries globally. Health care regionalization aims at improving patients' outcomes.
OBJECTIVES: This study examines the association between trauma center designation levels in the United States and survival of patients with MVT-related injuries.
METHODS: We used the National Trauma Data Bank 2015 dataset for this retrospective study. We conducted descriptive and bivariate analyses. This was followed by a multivariate analysis to assess the association between trauma center level and survival to hospital discharge.
RESULTS: One hundred sixty-eight thousand five hundred twenty-four patients were included in this study. The mean age was 39.9 years (±19.5 years) with a male predominance (63.8%). Most patients were taken to level I (55.7%) and level II (35.9%) centers. The overall survival of patients with MVT injuries was 95.3%. Involved patients were occupant (64.8%), motorcyclist (17.3%), and pedestrian (12.7%). After adjusting for confounders, patients sustaining MVT injuries who were taken to level II and III trauma centers were less likely survive compared with those taken to level I centers (odds ratio = 0.89 [95% confidence interval 0.81-0.97] and odds ratio = 0.70 [95% confidence interval 0.59-0.82], respectively).
CONCLUSIONS: In this study, we identified a survival benefit for patients with MVT injuries when treated at level I compared with level II and III centers. These findings provide additional evidence for the benefit of health care regionalization in the form of trauma center level designation.