Both level I and level II trauma centers treat patients with multiple traumas. Level I centers are also required to staff a 24-hour surgical critical care service, train residents, conduct research, and have a minimum case volume. A new study found that injured patients admitted to level I centers had a lower risk of dying than those admitted to level II centers.
The researchers compared mortality and complications for 208,866 patients admitted to 28 level I and level II trauma centers in Pennsylvania between 2000 and 2009. All patients were 16 years of age and older. The researchers took note of any complications that occurred during the initial hospitalization. They also estimated the independent effect of trauma center designation on in-hospital death.
Level I centers received 72 percent of the patients studied, while level II centers received 28 percent. Patients treated at a level I center were more likely to be younger and male. Patients admitted to level I centers had a 15 percent lower odds of dying than patients admitted to level II centers. This increased survival benefit was strongest for patients with very severe injuries. Similar mortality risk reductions were also seen for level I admissions of patients with blunt injuries or penetrating injuries. However, level I patients had a 37 percent increased odds of major complications compared to level II patients.
The study was supported by AHRQ (HS16737). See "Impact of trauma center designation on outcomes: is there a difference between level I and level II trauma centers?" by Laurent G. Glance, M.D., Turner M. Osler, M.D., FACS., Dana B. Mukamel, Ph.D., and Andrew W. Dick, Ph.D., in the September 2012 Journal of the American College of Surgeons 215(3), pp. 372-377.