"Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. Now we have conclusive data to show that trauma care is effective," said the study's lead author, Ellen J. MacKenzie, PhD, professor and chair of the Department of Health Policy and Management at the Bloomberg School of Public Health. "The findings of this study argue strongly for continued efforts at regionalizing trauma care at the state and local levels to assure that patients who suffer serious injuries get to a trauma center where they are afforded the best possible care."
The National Study on the Costs and Outcomes of Trauma analyzed the outcomes of 5,190 adult trauma patients who received treatment at 18 level 1 trauma centers (the highest level of care) and 51 non-trauma centers. The researchers also analyzed the characteristics of each hospital, such as the number of patients treated and types of specialty services available.
After adjusting for factors such as severity of injury, patient age and pre-existing medical conditions, the researchers found a 25 percent overall decrease in the risk of death following care in a trauma center compared to receiving care at a non-trauma center. The adjusted in-hospital death rate was 7.6 percent for patients treated at trauma centers compared to 9.5 percent for patients treated at non-trauma facilities. The mortality rate one year following the injury was 10.4 percent for patients at trauma centers compared to 13.8 percent for patients at non-trauma centers.
The researchers noted that the effect of treatment at trauma centers was less significant among older patients with underlying health problems.
"This study provides convincing evidence that care at a level 1 trauma center saves lives," said Gregory Jurkovich, MD, a University of Washington professor of surgery and a co-author of the study. "Our next step is to see if level 1 trauma center care also improves the quality of life of trauma survivors. We'll examine the differences in functional outcome and cost of care between level 1 trauma centers and non-trauma centers."
Caring for the acutely injured is a major public health issue and involves bystanders and community members, health care professionals and health care systems. "This research provides state and community leaders with crucial information, so that they can make sound decisions regarding their trauma systems and the care that people receive after they are injured. It is one way that the Centers for Disease Control contributes to reducing premature death and disability through research and partnerships," said Richard C. Hunt, MD, director of the CDC's Injury Center's Division of Injury Response.
Additional study authors are Frederick P. Rivara, MD, MPH, and Avery B. Nathens, MD, PhD, from the University of Washington School of Medicine; and Katherine P. Frey, MPH, Brian L. Egleston, MPP, David S. Salkever, PhD, and Daniel O. Scharfstein, ScD, from the Johns Hopkins Bloomberg School of Public Health.
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