Better Outcomes at Level I vs. Level II Trauma Centers Summary and Comment by John A. Marx, MD, FAAEM, FACEP Published in Journal Watch Emergency Medicine.

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Better Outcomes at Level I vs. Level II Trauma Centers Summary and Comment by John A. Marx, MD, FAAEM, FACEP Published in Journal Watch Emergency Medicine June 26, 2009Journal Watch Emergency Medicine Patients initially transported to level I trauma centers had better survival and functional outcomes. CopyrightCopyright © Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

Covering Cudnik MT et al. Level I versus level II trauma centers: An outcomes-based assessment. J Trauma 2009 May; 66:1321. CopyrightCopyright © Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

Background To determine differences in outcomes between patients taken to level I and level II trauma centers, investigators conducted a retrospective cohort analysis of consecutive patients (age, >15 years) who were transported directly by emergency medical services to all 11 level I (10,070 patients) and 16 level II (8033 patients) trauma centers in Ohio from 2003 through Patients who had isolated hip injuries or who were transferred between the two types of centers were excluded. CopyrightCopyright © Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

The Research Patients at level I trauma centers were significantly younger than those at level II centers (mean age, 44 vs. 51 years) and had significantly higher mean Injury Severity Scores (ISSs; 15 vs. 11). A significantly greater proportion of patients at level I trauma centers had penetrating injuries (14% vs. 11%), ISS ≥16 (36% vs. 22%), EMS Glasgow Coma Scale scores ≤8 (36% vs. 32%), and administration of intravenous fluids during EMS transport (44% vs. 34%). Mortality rates were significantly lower at level I trauma centers than at level II centers, both overall (odds ratio, 0.75) and in the subgroups of patients who had ISS >15 (OR, 0.76), blunt injury (OR, 0.72), penetrating injury (OR, 0.75), head injury (OR, 0.66), and pelvic fracture (OR, 0.49). CopyrightCopyright © Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

The Research Patients at level I centers were more likely than those at level II centers to be discharged home (OR, 1.14) or to a rehabilitation center or skilled nursing facility (OR, 1.39). CopyrightCopyright © Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

Comment The superior survival and functional outcomes at level I trauma centers could be ascribed to greater experience (average census was approximately double that at level II centers), greater availability of resources and personnel (e.g., in-house neurosurgeons), and earlier implementation of enhanced management strategies (resulting from greater research and education commitments). If a prospective study confirms these findings, prehospital trauma destination policies for specific patient groups should be adjusted accordingly. CopyrightCopyright © Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

About Journal Watch Journal Watch helps physicians and allied heath professionals save time and stay informed by providing brief, clearly written, clinically focused perspectives on the medical developments that affect practice. Journal Watch is an independent, trustworthy source, from the publishers of the New England Journal of Medicine. These slides were derived from Journal Watch Emergency Medicine.Journal Watch Emergency Medicine The best way to stay informed with Journal Watch, is through our alerts. To sign up, visit the My Alerts page.My Alerts page CopyrightCopyright © Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society