title: Improving outcomes in a regional trauma system: impact of a level III trauma center.
abstract: BACKGROUND
  Trauma systems decrease morbidity and mortality of injured populations, and each component contributes to the final outcome. This study evaluated the association between a referring hospital's trauma designation and the survival and resource utilization of patients transferred to a level I trauma center.
  
  
  METHODS
  Data from the Registry of the American College of Surgeons on patients transferred to a level I trauma center during a 7-year period were subdivided into 3 categories: group 1 = level III-designated trauma center; group 2 = potential level III trauma centers; and group 3 = other transferring hospitals. Trauma and Injury Severity Score methodology was used to provide a probability estimate of survival adjusted for the effect related to injury severity, physiologic host factors, and age. A W statistic was calculated for each type of referring hospital so that comparisons between observed survival and predicted survival could be measured. Differences in W, length of stay, intensive care unit days, and ventilator days were examined using general linear models.
  
  
  RESULTS
  Patients transferred to a level I from a level III trauma center (group 1) were more seriously injured (P < .0001) and had improved survival (P < .0018) compared with those transferred from nondesignated hospitals (groups 2 and 3). Patients transferred from large nondesignated hospitals (group 2) had outcomes similar to patients transferred from all other hospitals (group 3). Level I hospital resource utilization did not show significant differences based on referring hospital type.
  
  
  CONCLUSIONS
  Outcomes of patients in a trauma system are associated with trauma-center designation of the referring hospitals.
authors.affiliation: Department of Surgery, Cleveland Regional Medical Center, 200 W. Grover St., Shelby, NC 28150, USA. mikebarringer@carolina.rr.com
authors.forename: Michael L
authors.initials: ML
authors.lastname: Barringer
authors.forename: Michael H
authors.initials: MH
authors.lastname: Thomason
authors.forename: Patrick
authors.initials: P
authors.lastname: Kilgo
authors.forename: Linda
authors.initials: L
authors.lastname: Spallone
mesh_terms: D006295:Health Resources / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016014:Linear Models; D009657:North Carolina / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation; D012041:Regional Medical Programs; D012042:Registries; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality*