Reduced mortality at a community hospital trauma center - The impact of changing trauma level designation from II to I

Objective: To determine if a change in trauma designation from level II (L2) to level I (L1) in the same institution reduces mortality. Design, Setting, and Patients: A retrospective cohort study of all patients consecutively admitted to a community hospital trauma center. Intervention: The upgrade to trauma L1 designation (January 1, 2003-March 31, 2007) (n=7902) from trauma L2 designation (January 1, 1998-December 31, 2002) (n=9511). Main Outcome Measure: Adjusted overall mortality and adjusted mortality for severely injured patients, patients with complications, and patients with severe sites of injury. Results: After adjusting for age, sex, Injury Severity Score, mechanism of injury, hypotension on admission, respirations, and comorbidities, there was a significant decrease in overall mortality during L1 designation compared with L2 designation (2.50% vs 3.48%; P=.001). Severely injured patients (Injury Severity Score of ? 15) admitted during an L1 trauma designation had a significant reduction in mortality compared with patients admitted during an L2 designation (8.99% vs 14.11%; P <.001). Patients admitted during an L1 designation with a severe head, chest, or abdominal or pelvic injury diagnosis had a significant decrease in mortality (9.96% vs 14.51% [P=.005], 7.14% vs 11.27% [P=.01], and 6.76% vs 17.05%D [P=.002], respectively), as did patients who developed acute respiratory distress syndrome during their hospital stay (9.51% vs 26.87%; P=.02). Conclusions: The significant reduction in mortality of trauma patients with severe or specific injuries after the change to a higher trauma level designation may justify direct triage of these patients to L1 facilities, when available.