Moving beyond personnel and process: a case for incorporating outcome measures in the trauma center designation process

Arch Surg. 2008 Feb;143(2):115-9; discussion 120. doi: 10.1001/archsurg.2007.29.


Hypothesis: Similarly designated trauma centers do not achieve similar outcomes.

Design: Outcomes study.

Setting: Academic research.

Participants: Forty-seven American College of Surgeons-verified level I trauma centers that contributed more than 1000 patients to the National Trauma Data Bank (from January 1999 to December 2003) were identified.

Main outcome measures: Patients were classified into the following 3 injury severity groups using a combination of anatomical and physiological measures: mild (Injury Severity Score [ISS] of <25 with systolic blood pressure [SBP] of >/=90 mm Hg [n = 184 650]), moderate (ISS of >/=25 with SBP of >/=90 mm Hg or ISS of <25 with SBP of <90 mm Hg [n = 22 586]), and severe (ISS of >/=25 with SBP of <90 mm Hg [n = 4243]). The mean survival for each group was calculated. Individual centers were considered outliers if their patient survival was statistically significantly different from the mean survival for each severity group.

Results: The mean survival of patients with mild, moderate, and severe injuries was 99%, 75%, and 35%, respectively. For mild injuries, survival at 5 centers (11%) was significantly worse than that at their counterpart centers. With increasing injury severity, the percentages of outcome disparities increased (15% of centers for moderate injuries and 21% of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries, and older (>55 years) individuals.

Conclusions: When treating patients with similar injury severity, similarly designated level I trauma centers may not achieve similar outcomes, suggesting the existence of a quality chasm in trauma care. Trauma center verification may require the use of outcome measures when determining trauma center status.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Confidence Intervals
  • Female
  • First Aid / standards*
  • First Aid / trends
  • Health Care Surveys
  • Health Services Research
  • Hospital Mortality / trends*
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Outcome Assessment, Health Care*
  • Probability
  • Registries
  • Sex Distribution
  • Survival Analysis
  • Trauma Centers / standards*
  • Trauma Centers / trends
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / therapy