• Ellen J MacKenzie, Frederick P Rivara, Gregory J Jurkovich, Avery B Nathens, Katherine P Frey, Brian L Egleston, David S Salkever, and Daniel O Scharfstein.
• Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, MD 21205-1996, USA. emackenz@jhsph.edu
• N. Engl. J. Med. 2006 Jan 26; 354 (4): 366-78.

BackgroundHospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers).MethodsMortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers.ResultsAfter adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries.ConclusionsOur findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.Copyright 2006 Massachusetts Medical Society.

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