Care at a trauma center lowers by 25 percent the risk
of death for injured patients compared to treatment
received at nontrauma centers, according to the results of
a nationwide study conducted by researchers at the Johns
Hopkins Bloomberg School
of Public Health and the University of Washington
School of Medicine. "A National Evaluation of the Effect of
Trauma Center Care on Mortality," published in the Jan. 26
edition of the New England Journal of Medicine, is among
the first studies to provide strong evidence of the
effectiveness of specialized trauma care facilities.
"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, professor and chair of the
Department of Health Policy and Management at the
Bloomberg School. "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 nontrauma 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 nontrauma 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 nontrauma 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
nontrauma centers.
The researchers noted that the effect of treatment at
trauma centers was less significant among older patients
with underlying health problems.
Gregory Jurkovich, a University of Washington
professor of surgery and a co-author of the study, said,
"This study provides convincing evidence that care at a
Level 1 trauma center saves lives. 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 nontrauma 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.
Richard C. Hunt, director of the CDC's Injury Center's
Division of Injury Response, said, "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."
Funding for the study was provided by the Centers for
Disease Control and Prevention's National Center for Injury
Prevention and Control and the National Institutes of
Health's National Institute on Aging.
Additional study authors from Johns Hopkins are
Katherine P. Frey, Brian L. Egleston, David S. Salkever and
Daniel O. Scharfstein.
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