Journal of Emergencies, Trauma, and Shock
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ORIGINAL ARTICLE
Year : 2020  |  Volume : 13  |  Issue : 3  |  Page : 201-207

Variability in current trauma systems and outcomes


1 Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
2 Department of Trauma, HCA-South Atlantic Division, Charleston, SC, USA
3 Department of Surgery, Kendall Regional Medical Center, Miami; Department of Surgery, University of South Florida, Tampa, FL, USA

Correspondence Address:
Dr. Adel Elkbuli
Kendall Regional Medical Center, 11750 Bird Road, Miami, FL 33175
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_49_19

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Background: Complication rates may be indicative of trauma center (TC) performance. The complication rates between Level 1 and 2 TCs at the national level are unknown. Our study aimed to determine the relationship between American College of Surgeons (ACS)-verified and state-designated TCs and complications. Study Design and Methods: This was a cohort review of the National Sample Program (NSP) from the National Trauma Data Bank, the world's largest validated trauma database. TCs were categorized by ACS or state Level 1 or 2. TCs not categorized as Level 1 or 2 were excluded. All 22 complications provided by the NSP were analyzed. Chi-squared analysis was used with statistical significance defined asP < 0.05.Results: Of the 94 TCs in the NSP, 67 had ACS and 80 had state designations of Level 1 or 2. There were 38 ACS Level 1 TCs treating 87,340 patients and 29 ACS Level 2 TCs treating 35,763. There were 45 state Level 1 TCs treating 106,640 and 35 state Level 2 TCs treating 43,290. ACS Level 1 TCs had significantly higher complications compared to ACS Level 2 TCs (13.5% [11,776/87,340] vs. 10.1% [3,606/35,763],P < 0.0001). In addition, state Level 1 TCs had significantly more complications compared to state Level 2 TCs (4.4% [4,681/106,640] vs. 1.6% [673/43,290],P < 0.0001). Conclusion: Both ACS and state Level 2 TCs had significantly lower complication rates than ACS and state Level 1 TCs. Further investigations should look for the source and impact of this difference.


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