Characteristics of ACS-verified Level I and Level II trauma centers
- 1 October 2016
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 81 (4), 735-742
- https://doi.org/10.1097/ta.0000000000001136
Abstract
The Trauma Quality Improvement Project of the American College of Surgeons (ACS) has demonstrated variations in trauma center outcomes despite similar verification status. The purpose of this study was to identify structural characteristics of trauma centers that affect patient outcomes. Trauma registry data on 361,187 patients treated at 222 ACS-verified Level I and Level II trauma centers were obtained from the National Trauma Data Bank of ACS. These data were used to estimate each center's observed-to-expected (O-E) mortality ratio with 95% confidence intervals using multivariate logistic regression analysis. De-identified data on structural characteristics of these trauma centers were obtained from the ACS Verification Review Committee. Centers in the lowest quartile of mortality based on O-E ratio (n = 56) were compared to the rest (n = 166) using Classification and Regression Tree (CART) analysis to identify institutional characteristics independently associated with high-performing centers. Of the 72 structural characteristics explored, only 3 were independently associated with high-performing centers: annual patient visits to the emergency department of fewer than 61,000; proportion of patients on Medicare greater than 20%; and continuing medical education for emergency department physician liaison to the trauma program ranging from 55 and 113 hours annually. Each 5% increase in O-E mortality ratio was associated with an increase in total length of stay of one day (r = 0.25; p < 0.001). Very few structural characteristics of ACS-verified trauma centers are associated with risk-adjusted mortality. Thus, variations in patient outcomes across trauma centers are likely related to variations in clinical practices. Therapeutic study, level III.Keywords
This publication has 18 references indexed in Scilit:
- Frequency of Adoption of Practice Management Guidelines at Trauma CentersBaylor University Medical Center Proceedings, 2013
- Methodology and Analytic Rationale for the American College of Surgeons Trauma Quality Improvement ProgramJournal of the American College of Surgeons, 2013
- Effect Of Trauma Center Status on 30-Day Outcomes After Emergency General SurgeryJournal of the American College of Surgeons, 2011
- The Trauma Quality Improvement Program: Pilot Study and Initial Demonstration of FeasibilityThe Journal of Trauma and Acute Care Surgery, 2010
- The Trauma Quality Improvement Program of the American College of Surgeons Committee on TraumaJournal of the American College of Surgeons, 2009
- Relationship Between American College of Surgeons Trauma Center Designation and Mortality in Patients with Severe Trauma (Injury Severity Score > 15)Journal of the American College of Surgeons, 2006
- A National Evaluation of the Effect of Trauma-Center Care on MortalityThe New England Journal of Medicine, 2006
- American College of Surgeons, Committee on Trauma Verification Review: Does it Really Make a Difference?The Journal of Trauma and Acute Care Surgery, 2002
- Effectiveness of State Trauma Systems in Reducing Injury-Related Mortality: A National EvaluationThe Journal of Trauma and Acute Care Surgery, 2000
- The Quality of CareJAMA, 1988