title: Do trauma centers improve functional outcomes: a national trauma databank analysis?
abstract: BACKGROUND
  The development of a tiered trauma care system has lead to improved survival for the critically injured. The question as to whether the increased survival associated with the establishment of tiered levels of trauma care is paralleled by an improved functional outcome has not, however, been addressed.
  
  
  METHODS
  Multivariate logistic regression analysis of the National Trauma Data Bank from 1994 to 2001 was performed with functional independence measure (FIM) as the primary outcome. Trauma centers were dichotomized as Level II or above versus Level III or below. Blunt and penetrating trauma patients were analyzed separately. Other covariates included age, gender, shock, comorbidities, alcohol, drugs, as well as head, chest, abdominal, spine, and lower extremity injury. Confidence intervals were set at an alpha of 0.05.
  
  
  RESULTS
  A total of 474,024 patients were analyzed. Among minimally injured penetrating trauma patients, those receiving care at a higher tiered center had a higher likelihood of total independence (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.0, 2.0). Among minimal, moderate and severely injured blunt trauma patients those receiving care at a higher tiered center had a higher likelihood of total independence (OR = 1.2, 95% CI = 1.0, 1.4, OR = 1.3, 95% CI = 1.1, 1.6, OR = 1.3, 95% CI = 1.3, 1.5, respectively).
  
  
  CONCLUSIONS
  These data indicate that the complex care delivered by advanced level trauma centers is associated with improved functional outcomes. Further investigations to identify the reasons for differences in these outcomes are necessary to improve care at lower tiered hospitals particularly for minimally injured patients.
authors.affiliation: Medical College of Wisconsin, Division of Trauma and Critical Care, Milwaukee, Wisconsin 53226, USA. rnirula@mcw.edu
authors.forename: Ram
authors.initials: R
authors.lastname: Nirula
authors.forename: Karen
authors.initials: K
authors.lastname: Brasel
mesh_terms: D000203:Activities of Daily Living; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods; D012042:Registries / Q000706:statistics & numerical data; D016019:Survival Analysis; D014193:Trauma Centers / Q000145:classification / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000534:rehabilitation*; D014949:Wounds, Nonpenetrating / Q000534:rehabilitation; D014950:Wounds, Penetrating / Q000534:rehabilitation