Not All Trauma Centers Equal -- Study

NEW YORK (Reuters Health) - Survival after the most severe traumatic injuries is significantly better at level I trauma centers than at level II trauma centers, according to a new report.

"Although it is the first study to show this difference, it is not an unexpected finding," Dr. Demetrios Demetriades from University of Southern California, Los Angeles, told Reuters Health. "Level I centers are academic facilities with stricter requirements and more resources."

Demetriades and his colleagues compared outcomes of 12,254 trauma patients with specific severe injuries after treatment at level I or level II trauma centers.

The overall mortality rate among patients treated at level I trauma centers was 25.3 percent, the investigators report in the Annals of Surgery, compared with 29.3 percent at level II trauma centers.

After adjustment for injury severity scores, the mortality at level I trauma centers was nearly 20 percent lower than that at level II trauma centers or all other centers.

Functional abilities of the patients when they came to be discharged from the hospital were also better overall at level I centers, the researchers note, with a significantly lower rate of total functional independence in survivors (20.3 percent) compared with level II centers (33.8 percent).

The findings "may have practical implications in the planning of trauma systems, triage of patients to trauma centers, and financial compensation of services according to level of center accreditation," the team writes.

"The public must understand that both level I and II trauma centers are essential for an effective trauma system," Dr. Demetriades added. "Logistically and practically you need to have both levels. The injuries that benefited from level I centers are only about 1 percent of all trauma admissions. It is not advisable to build a trauma system based exclusively on this 1 percent of the victims."

SOURCE: Annals of Surgery, October 2005.