CHAPTER 91 LEVEL ONE TRAUMA CENTERS

A National Evaluation of the Effect of Trauma-center Care on Mortality

MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. N Engl J Med. 2006;354(4):366–378

BACKGROUND

As emergency care became more recognized nationally and trauma care algorithms developed, the American College of Surgeons led efforts to regionalize and certify trauma centers to ensure timely trauma care across the United States. This stratification of care was rational but lacked evidence showing a clear mortality benefit. Studies that had been done were complicated by methodologic flaws such as referral bias.

OBJECTIVES

To evaluate the effect of care at a Level I trauma center compared to a nontrauma center on in-hospital and 1-year mortality.

METHODS

A prospective, multicenter observational trial conducted at 18 Level I trauma centers and 51 large nontrauma centers in the United States between 2001 and 2002.

Participants

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