Outcome analysis of Pennsylvania trauma centers: factors predictive of nonsurvival in seriously injured patients.
BACKGROUND
The purpose of this study was to evaluate the impact of five trauma center characteristics on survival outcome in nine serious injury categories.


METHODS
A retrospective analysis of prospectively collected data from 1992 to 1996 on patients older than 14 years of age from 24 accredited trauma centers in Pennsylvania was performed. Trauma center characteristics selected for evaluation were level of accreditation, volume of trauma admissions, presence of in-house trauma surgeons, presence of a surgical residency program, and presence of an on-site medical school. Each of these characteristics was evaluated to determine its impact on survival in the selected serious injuries. A logistic regression model was then created to evaluate the most seriously injured patients as defined by A Severity Characterization of Trauma score of < 0.50. On the basis of the logistic regression model, odd ratios were calculated treating low volume as a significant risk factor for mortality.


RESULTS
Of the 88,723 patients meeting registry criteria, 13,942 met the serious injury criteria. Independent analysis suggested that accreditation was beneficial regardless of level, volume of patients treated had a direct impact on survival outcome, and the presence of a surgical residency program may confer survival benefit. Of the 13,942 patients with serious injuries, those with A Severity Characterization of Trauma score of < 0.5 were selected for evaluation by logistic regression (n = 3,562). The logistic regression model, however, showed that only volume of patients treated had a consistent association with improved survival. Odds ratio analysis revealed low volume as a significant risk factor for mortality in seven of the nine injuries studied.


CONCLUSIONS
In this analysis, only volume of patients treated had a direct impact on survival outcome. Accreditation, regardless of level, appears to be beneficial.
Pasquale
M D
MD
Department of Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
Peitzman
A B
AB
Bednarski
J
J
Wasser
T E
TE
D000068:Accreditation; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012577:Schools, Medical / Q000706:statistics & numerical data; D016019:Survival Analysis; D014193:Trauma Centers / Q000592:standards*; D015599:Trauma Severity Indices