• Shahid Shafi, Sunni A Barnes, Nadine Rayan, Rustam Kudyakov, Michael Foreman, H Gil Cryer, Hasan B Alam, William Hoff, and John Holcomb.
• Baylor Health Care System, Dallas, TX. Electronic address: shahid.shafi@baylorhealth.edu.
• J. Am. Coll. Surg. 2014 Aug 1; 219 (2): 189-98.

BackgroundState health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality.Study DesignThis retrospective observational study was conducted at 5 Level I trauma centers across the country. Participants were adult patients with moderate to severe injuries (n = 3,867). The association between compliance with 22 commonly recommended clinical practices and in-hospital mortality was measured after adjusting for patient demographics and injuries and their severity.ResultsCompliance with individual clinical practices ranged from as low as 12% to as high as 94%. After adjusting for patient demographics and injury severity, each 10% increase in compliance with recommended care was associated with a 14% reduction in the risk of death. Patients who received all recommended care were 58% less likely to die (odds ratio = 0.42; 95% CI, 0.28-0.62) compared with those who did not.ConclusionsCompliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality.Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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