Hospitals designated as trauma centers by the American College of Surgeons (ACS) have lower complication rates than non-ACS trauma centers, according to a retrospective review.
Dr. Michael D. Grossman from Hofstra-Northwell School of Medicine and Southside Hospital in Bayshore, New York and colleagues used data from the National Sample Program of the National Trauma Data Bank to compare complications and mortality, independent of volume, between ACS and non-ACS trauma centers in the U.S.
They divided patients into groups by age (pediatric, 0 to 14 years; adult, 15 to 64 years; and elderly, older than 65 years) and by Injury Severity Score (all injuries, ISS 9 to 74; major injuries, ISS 25 to 74).
Overall, mortality and complication rates did not differ between ACS and non-ACS centers. Among elderly patients, however, complications were 3.17-fold more likely in non-ACS centers, whereas statistically significant differences in mortality were likely not clinically significant, the authors reported on June 6 online in the Journal of the American College of Surgeons.
Similarly, for children, mortality rates were similar at ACS and non-ACS centers, but complications were 2.61-fold more likely in non-ACS centers. For adults with major trauma, death was 13 percent less likely in non-ACS trauma centers than in ACS trauma centers, with most of the difference attributable to death in the emergency department (5.2 percent at ACS centers versus 2.0 percent at non-ACS centers).
Mortality rates in children and the elderly with major trauma did not differ between ACS and non-ACS centers, but complications were significantly more likely in non-ACS centers for adult, elderly, and pediatric patients with major trauma.
“Although our study is limited by factors affecting large database analyses including missing data elements, lack of detail regarding causation of outcomes measures (death in the ED), and inability to accurately determine the effect of transfer status on outcomes, we believe it is possible to conclude that complications are more likely in non-ACS trauma centers at the extremes of age for patients with less severe injury and for all ages in patients with more severe injury,” the researchers write.
It’s not clear yet, they say, which standards, requirements, or clinical characteristics make the most difference with regard to outcome.
Dr. Joshua B. Brown from the University of Pittsburgh Medical Center in Pennsylvania, who recently examined the effect of geographic trauma system resource organization on fatal motor vehicle collisions, told Reuters Health by email, “I think the most interesting finding is that the benefit appears to be largely in the extremes of age. Our geriatric and pediatric patients have been shown to benefit from specialized trauma care, so a reduction in complications is a real opportunity to improve care in these vulnerable patient populations.”