Abstract
Background
Ground-level falls (GLFs) are the predominant mechanism of injury in US trauma centers
and accompany a spectrum of comorbidities, injury severity, and physiologic derangement.
Trauma center levels define tiers of capability to treat injured patients. We hypothesized
that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would
evaluate the degree to which need for care was met by provision of care.
Materials and methods
This retrospective cohort study used National Trauma Data Bank files for 2007-2014.
Trauma center level was defined as American College of Surgeons (ACS) level I/II,
ACS III/IV, State I/II, and State III/IV for within-group homogeneity. Risk-adjusted
expected mortality was estimated using hierarchical, multivariable regression techniques.
Results
Analysis of 812,053 patients' data revealed the proportion of GLF in the National
Trauma Data Bank increased 8.7% (14.1%-22.8%) over the 8 y studied. Mortality was
4.21% overall with a three-fold increase for those aged 60 y and older versus younger than 60 y (4.93% versus 1.46%, P < 0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI: 0.971-0.975) and highest
for State III/IV (1.043, 95% CI: 1.041-1.044).
Conclusions
Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma
centers. Differential O:E for ACS III/IV and State III/IV centers suggests that factors
beyond case mix alone influence outcomes for GLF patients. More work is needed to
optimize trauma care for GLF patients across the spectrum of trauma center capability.
Keywords
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Article info
Publication history
Published online: January 06, 2017
Accepted:
December 30,
2016
Received in revised form:
November 28,
2016
Received:
September 27,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
