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 MEASURES: 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% [P = .002], respectively), as did patients who developed acute respiratory distress syndrome during their hospital stay (9.51% vs 26.87%; P = .02).
CONCLUSION: 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.