Major complications more likely at trauma centers in Midwest, South, West

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A recent study from Indiana University examines the relationship between trauma center volumes and in-hospital outcomes. The results support previous findings linking higher volumes to lower mortality rates. However, the research did uncover surprising regional disparities in trauma patient complication rates.

The study was published ahead-of-print on February 12 in the Journal of Surgical Research. The investigators examined records in the National Trauma Data Bank for patients treated at Level I and Level II trauma centers between 2008 and 2010. The analysis included more than 350,000 patients who received care at 264 designated trauma centers. The goal of the study was to determine whether trauma center volume influenced complications, failure-to-rescue (FTR) and mortality. The study controlled for severity, type and mechanism of injury as well as other factors.

The main findings support the well observed link between volume and mortality. Higher trauma center volumes were significantly associated with lower likelihood of in-hospital death. The data did show large differences in complication rates between hospitals in different volume quintiles, but these differences disappeared after adjusting for patient and hospital characteristics. Similarly, the probability of a patient experiencing FTR did not differ significantly based on trauma center volume.

However, the study did uncover significant differences between hospital regions with regard to complications and death following a complication.

  • Complications: Patients treated at trauma centers in the Midwest, West and South had a significantly higher probability of developing a complication. Compared to patients in the Northeast, the odds of developing a complication were 66% higher for patients in the Midwest and South and 61% higher for patients in the West.
  • Failure to rescue: Patients treated at trauma centers in the South had 39% higher odds of dying after a complication than patients treated in Northeastern centers.

The authors of the study speculate that these differences could be due to regional variation in treatment patterns. They also note possible state and regional variations in access to trauma care, trauma system development and training quality.

The findings suggest the limitations of regional trauma data sets. “We found that both hospital characteristics and outcomes varied significantly by region,” the authors wrote. “Limiting analyses to data from a single state will most likely not have the power to detect the effects of hospital characteristics. Additionally, state-based analyses cannot be used to determine national estimates and have the potential to produce biased results due to the wide variation in trauma outcomes across regions.”