Trauma centers are designated by the American College of Surgeons (ACS) into four different levels based on resources, volume, and scientific and educational commitment. The purpose of this study was to evaluate the relationship between ACS center designation and outcomes after early
thoracotomy for trauma. The National Trauma Databank (v. 7.0) was used to identify all patients who required early thoracotomy. Demographics, clinical data, and outcomes were extracted. Patients were categorized according to ACS trauma center designation. Multivariate logistic regression was
used to evaluate the impact of ACS trauma center designation on mortality. From 2002 to 2006, 1834 (77.4%) patients were admitted to a Level I ACS verified trauma center, 474 (20.0%) to a Level II, and 59 (3.6%) to a Level III/IV facility. After adjusting for differences between the groups,
there were no significant differences in mortality (overall: 53.3% for Level I, 63.1% for Level II, and 52.5% for Level III/IV, adjusted P = 0.417; or for patients arriving in cardiac arrest: 74.9% vs 87.1% vs 85.0%, P = 0.261). Subgroup analysis did not show any
significant difference in survival irrespective of mechanism of injury. Glasgow Coma Scale score ≤ 8, Injury Severity Score > 16, no admission systolic blood pressure, time from admission to thoracotomy, and nonteaching hospitals were found to be independent predictors of death. For
trauma patients who have sustained injuries requiring early thoracotomy, ACS trauma center designation did not significantly impact mortality. Nonteaching institutions however, were independently associated with poorer outcomes after early thoracotomy. These findings may have important implications
in educational commitment of institutions. Further prospective evaluation of these findings is warranted.
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Document Type: Research Article
Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California, USA
Publication date: January 1, 2012
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