• Sarah Traboulsy, Joe Demian, Rana Bachir, and Mazen El Sayed.
• Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: st61@aub.edu.lb.
• Am J Emerg Med. 2025 Jan 13; 90: 717771-77.

BackgroundTrauma is the leading non obstetric cause of death in pregnant women. Pregnancy above 20 weeks falls under special considerations group in the Center for Disease Control and Prevention (CDC) field triage criteria. Trauma centers' designation level in the United States is based on available resources for care.AimIn this study, we examine the association between trauma center designation level and survival of pregnant patients presenting to the Emergency Department (ED) after a traumatic injury.MethodsThis retrospective observational study included all pregnant women of reproductive age (16 years and above) who experienced any form of trauma and were registered in the National Trauma Data Bank 2020 dataset. Descriptive analysis was carried out. All variables were stratified by the trauma designation levels. Firth logistic regression was conducted to examine the association between trauma designation levels and survival to hospital discharge after controlling for all potential confounding factors.ResultsA total of 1612 patients were included in this study. The average age was 27.2 (±6.9 years). Most patients were taken to level I (58.3 %) and II (33.9 %) centers. Overall survival of patients after pregnancy trauma was 97.2 %. After adjusting for confounders, patients taken to level II and III trauma centers had similar survival to hospital discharge compared with those taken to level I centers [OR = 2.561, 95 % CI: 0.644-10.182 and OR = 4.886, 95 % CI: 0.584-40.862 respectively].ConclusionIn this study, trauma center designation level did not impact survival of pregnant patients sustaining injuries. This provides further evidence that the CDC's field triage guidelines, including their specific considerations for pregnant patients are accurate and that the current practice seems to be effective.Copyright © 2025 Elsevier Inc. All rights reserved.

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