The impact of level of the American College of Surgeons Committee on Trauma verification and state designation status on trauma center outcomes

Abstract

The American College of Surgeons (ACS) Committee on Trauma (COT) verification and State designation of trauma centers (TCs) into Level 1 or 2 establishes a distinction based on resources, trauma volume, and educational commitment. The ACS COT and individual states each verify TCs to differentiate performance levels. We aim to determine the relationship between ACS and State Level 1 versus 2, and injury-adjusted, all-cause mortality in a national sampling. TCs were identified by review of the National Sample Program (NSP) from the National Trauma Data Bank (NTDB)—the largest validated trauma database in the nation—of the year 2013. TCs were categorized by ACS or State Level 1 or 2 status, all others were excluded. Adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived by trauma and injury severity score (TRISS) methodology. Chi-squared and t test analyses were used for categorical variables, with a statistical significance defined as P -value <.05. Of the 94 TCs in the NSP, 67 had ACS and 80 had State designations. There were 38 ACS Level 1 TCs and 29 ACS Level 2. For State designations, there were 45 as State Level 1 and 35 State Level 2. ACS Level 1 TCs had a similar O/E compared with ACS Level 2 verified centers (0.73 vs 0.75, chi-square, P = .36). Level 1 TCs designated by their state, had a similar O/E compared with State Level 2 centers (0.70 vs 0.74, chi-square, P = .08). Both ACS and State Level 1 and 2 trauma centers performed similarly on injury adjusted, all-cause mortality.

Sex-Based Disparities in Timeliness of Trauma Care and Discharge Disposition

“…The TQIP database consists of patient encounters of patients who were admitted to predominantly ACS-verified level I or II trauma centers, with penetrating or blunt traumatic injury. Patients attended mostly ACS level I and II centers; however, more than 30% were cared for in non–ACS-verified trauma centers where state designation is extremely variable and may be equivalent to ACS verification or considerably less strenuous with less oversight . Many state-designated level II trauma centers may function as level III trauma centers .…”

“…Patients attended mostly ACS level I and II centers; however, more than 30% were cared for in non-ACS-verified trauma centers where state designation is extremely variable and may be equivalent to ACS verification or considerably less strenuous with less oversight. 18 Many state-designated level II trauma centers may function as level III trauma centers. 19 Patients cared for at state-designated centers were included to improve the generalizability of our findings, as were the 4 patients who were cared for at ACS level III trauma centers.…”

Post-Mortem CT Delivers Fast and Accurate Injury Identification in Trauma Patients

“…[7][8][9] Both the American College of Surgeons (ACS) trauma center verification and state designation process rely on meeting certain trauma volume and acuity per year. 7,10 PMCT offers the potential to extend this more detailed injury assessment to trauma patients that expire before traditional CT imaging is feasible.…”

A Re-Evaluation of the Effect of Trauma Center Verification Level on the Early Risk of Death in Hemodynamically Unstable Patients

“…Superior outcomes are reported at level I centers for the severely injured [1,2], traumatic brain injury (TBI) patients [3,4], those with other specific injuries [5], and overall mortality [6,7]. Less prevalent are studies showing improved outcomes or equivalency at level II centers [8][9][10][11]. Of significance to our study, previous data show that trauma patients presenting with hemodynamic instability have significantly lower mortality in level I versus level II centers and that this discrepancy is sustained during the first hours of admission [2].…”