ACS trauma centre designation and outcomes of post-traumatic ARDS: NTDB analysis and implications for trauma quality improvement.

BACKGROUND: Several authors have examined the relationship between outcomes following severe trauma and American College of Surgeons (ACS) trauma centre designation. Little is known, however, about the association between ACS level and outcomes following complications of trauma.
METHODS: The National Trauma Databank (NTDB, v. 5.0) was queried to identify adult (age > or =18) trauma patients developing post-traumatic ARDS, who were admitted to either ACS level 1 or level 2 trauma centres from 2000 to 2004. Patients transferred between institutions and injuries following burns were excluded. Univariate analysis was used to assess differences between those patients admitted to ACS level 1 and level 2 facilities. Adjusted mortality was derived using logistic regression analysis.
RESULTS: A total of 902 adult trauma patients with ARDS after 48 h of mechanical ventilation were identified from the NTDB. Five hundred and thirty six patients were admitted to a level 1 ACS verified centre and 366 to a level 2 facility. Univariate analysis revealed no statistical differences in clinical and demographic characteristics between the two groups. On univariate comparison, patients admitted to level 1 facilities had longer mean hospital and ICU length of stay and higher hospital related charges than level 2 counterparts. Patients admitted to a level 1 centre were, however, significantly more likely to achieve discharge to home. Using multivariate logistic regression, ACS level designation was shown to have no statistical effect on mortality. Hypotension on admission and age greater than 55 were the only independent predictors of mortality.
CONCLUSION: ACS trauma centre designation level is not an independent predictor of mortality following post-traumatic ARDS.