Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers

Abstract

Objectives: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. Methods: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. Results: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). Conclusion: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.

Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: A systematic review and meta-analysis

“…Most (n = 32, 91%) studies were retrospective cohorts, 21–34,36,37,39,41–53,55 three (9%) studies were prospective cohorts 35,40,54 . The majority (n = 32, 91%) were United States based, 21–23,25–30,32–39,41–55 one study was conducted in France, 24 one in Israel, 40 and one study in Canada 31 . A total of 26 (74%) studies 22–27,29–32,34–36,38–40,43–52 compared Level I with Level II trauma centers.…”

“…The majority (n = 32, 91%) were United States based, 21–23,25–30,32–39,41–55 one study was conducted in France, 24 one in Israel, 40 and one study in Canada 31 . A total of 26 (74%) studies 22–27,29–32,34–36,38–40,43–52 compared Level I with Level II trauma centers. Other studies compared Level I with unranked, 54,55 Level I with IV and unranked, 42 Level I/II with III/IV, 21,41 Level I/II with unranked, 53 Level I with III, 33 Level I with II/III/IV, 37 Level I/II/III with unranked 28 …”

“…Of all 34 studies reporting in-hospital mortality, 21–49,51–55 11 studies (32%) 24,26,30–32,36,43,48,51,54,55 found Level I trauma centers are associated with lower in-hospital mortality versus non–Level I trauma centers (Table 1). Of these 11 studies, nine studies (82%) 24,26,30–32,36,43,48,51 compared Level I with Level II trauma centers.…”

“…Most (n = 32, 91%) studies were retrospective cohorts, [21][22][23][24][25][26][27][28][29][30][31][32][33][34]36,37,39,[41][42][43][44][45][46][47][48][49][50][51][52][53]55 three (9%) studies were prospective cohorts. 35,40,54 The majority (n = 32, 91%) were United States based, [21][22][23][25][26][27][28][29][30][32][33][34][35][36][37][38][39]…”

“…Of all studies, 21 studies (60%) 22,23,25,26,29,30,[32][33][34][35][37][38][39][43][44][45][46][47][48][49]52 reported ICU LOS comparing higher and lower level trauma centers (Table 1). A total of 10 studies (48%) 22,23,26,30,32,34,37,38,45,48 found lower level trauma centers associated with shorter ICU LOS compared with higher levels, seven studies (33%) 25,29,33,43,44,47,49 reported no significant differences in ICU LOS between higher and lower level trauma centers, and four studies (19%) 35,39,46,52 found a significant lower ICU LOS in Level I trauma centers.…”