Relationship between American College of Surgeons trauma center designation and mortality in patients with severe trauma (Injury Severity Score > 15)

Background: We studied the association of the American College of Surgeons (ACS) trauma center designation and mortality in adult patients with severe trauma (Injury Severity Score >15). ACS designation of trauma centers into different levels requires substantial financial and human resources commitments. There is very little work published on the association of ACS trauma center designation and outcomes in severe trauma. Study Design: National Trauma Data Bank study including all adult trauma admissions (older than 14 years of age) with Injury Severity Score (ISS)>15. The relationship between ACS level of trauma designation and survival outcomes was evaluated after adjusting for age, mechanism of injury, ISS, hypotension on admission, severe liver trauma, aortic, vena cava, iliac vascular, and penetrating cardiac injuries. Results: A total of 130,154 patients from 256 trauma centers met the inclusion criteria. Adjusted mortality in ACS-designated Level II centers and undesignated centers was notably higher than in Level I centers (adjusted odds ratio, 1.14; 95% CI, 1.09-120; p<0.0001 and adjusted odds ratio, 1.09; CI, 1.05-1.13; p<0.0001, respectively). Conclusions: Severely injured patients with ISS>15 treated in ACS Level I trauma centers have considerably better survival outcomes than those treated in ACS Level II centers.