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People with the most severe traumatic injuries have a significantly better chance of survival if they receive care at a level I trauma center rather than a level II center, according to new findings. The findings, though not surprising to researchers, are the first to document this difference between level I and level II centers.


Researchers studied 12,254 trauma patients with specific injuries associated with high mortality and poor functional outcomes. All patients had at least one of the following severe injuries: aortic, vena cava, iliac vessels, cardiac, or grade IV/V liver injuries; quadriplegia; or complex pelvic fractures.


The overall mortality rate was 25.3% at level I centers, compared with 29.3% at level II centers. But when researchers took injury severity into account, mortality rates at level I centers were nearly 20% lower than at level II centers. Patients' functional abilities at discharge were also better when they were treated at level I centers.


Researchers say their findings support triaging patients to trauma centers according to level of center accreditation. The severe injuries that are best treated at level I centers comprise only about 1% of all trauma admissions, so both levels of care are essential for an effective trauma care system.




The effect of trauma center designation and trauma volume on outcome in specific severe injuries, Annals of Surgery, D Demetriades, et al., October 2005.