Death rates vary among trauma centers

NEW YORK Tue Feb 3, 2009 8:45pm EST

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NEW YORK (Reuters Health) - Even after controlling for the severity of a traumatic injury, death rates vary significantly across similarly designated trauma centers, a study shows.

"Our results imply that the quality of trauma care is not consistent across similarly designated trauma centers despite the use of the designation process," the study team notes.

Dr. Shahid Shafi from the University of Texas Southwestern Medical School, Dallas, and colleagues measured death rates at 15 designated Level 1 and 2 trauma centers in Texas, after controlling for injury severity and other patient characteristics.

In an analysis, they found that age, mechanism of injury, severity of injury, initial systolic blood pressure, and scores on the Glasgow Coma Scale, which assesses a person's ability to answer simple questions, independently predicted death.

Compared with the best-performing center, 8 of the other 14 trauma centers had significantly worse odds of survival, while the remaining 6 had similar odds of survival.

The variability in outcomes found in this study may reflect variations in quality of care, the investigators say, and the reasons for this discrepancy "should be explored" as a means of improving trauma care quality.

It's possible, the investigators say, that current criteria used in the trauma center designation process "may not measure all of the resources needed to achieve best possible survival rates. Alternatively, it is possible that the factors that do influence outcome are not measured by the designation process."

"Either way," they add, "it appears that the designation process could be improved if the factors associated with differences in outcome can be identified and included in the process."

SOURCE: Archives of Surgery, January 2009.

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