Emergency department diversion and trauma mortality: Evidence from Houston, Texas

Background. This study examined the relation between trauma death rates and hospital diversion in the Houston emergency medical service area. Methods: A risk analysis and logistic regression were performed comparing death rates for trauma patients hospitalized on significant emergency department diversion days, defined as days when both of two level 1 hospitals were on diversion for more than 8 hours, and on nonsignificant diversion days, defined as one or both hospitals on diversion for fewer than 8 hours or not on diversion at all. Results: The percentage of deaths among all trauma patients, transfers, and nontransfers admitted on significant diversion days was consistently higher than on nonsignificant diversion days, but the difference was not statistically significant. A higher mortality rate, approaching statistical significance, was found for one subgroup of the most severe trauma patients who had been transferred from another hospital. Conclusions: A possible association between emergency department diversion and death rates in Houston trauma hospitals was found, particularly among the most severe trauma patients transferred from lower-level hospitals. A follow-up study is needed for further investigation of this relation.