title: Reduced mortality at a community hospital trauma center: the impact of changing trauma level designation From II to I.
abstract: OBJECTIVE
  To determine if a change in trauma designation from level II (L2) to level I (L1) in the same institution reduces mortality.
  
  
  METHODS
  A retrospective cohort study of all patients consecutively admitted to a community hospital trauma center.
  
  
  METHODS
  The upgrade to trauma L1 designation (January 1, 2003-March 31, 2007) (n = 7902) from trauma L2 designation (January 1, 1998-December 31, 2002) (n = 9511).
  
  
  METHODS
  Adjusted overall mortality and adjusted mortality for severely injured patients, patients with complications, and patients with severe sites of injury.
  
  
  RESULTS
  After adjusting for age, sex, Injury Severity Score, mechanism of injury, hypotension on admission, respirations, and comorbidities, there was a significant decrease in overall mortality during L1 designation compared with L2 designation (2.50% vs 3.48%; P = .001). Severely injured patients (Injury Severity Score of >/= 15) admitted during an L1 trauma designation had a significant reduction in mortality compared with patients admitted during an L2 designation (8.99% vs 14.11%; P < .001). Patients admitted during an L1 designation with a severe head, chest, or abdominal or pelvic injury diagnosis had a significant decrease in mortality (9.96% vs 14.51% [P = .005], 7.14% vs 11.27% [P = .01], and 6.76% vs 17.05% [P = .002], respectively), as did patients who developed acute respiratory distress syndrome during their hospital stay (9.51% vs 26.87%; P = .02).
  
  
  CONCLUSIONS
  The significant reduction in mortality of trauma patients with severe or specific injuries after the change to a higher trauma level designation may justify direct triage of these patients to L1 facilities, when available.
authors.affiliation: Trauma Research Department, Swedish Medical Center, 501 E Hampden Ave, Room 4-454, Englewood, CO 80113. dbaror@dmibio.com.
authors.forename: Kristin
authors.initials: K
authors.lastname: Scarborough
authors.forename: Denetta Sue
authors.initials: DS
authors.lastname: Slone
authors.forename: Phyllis
authors.initials: P
authors.lastname: Uribe
authors.forename: Michael
authors.initials: M
authors.lastname: Craun
authors.forename: Raphael
authors.initials: R
authors.lastname: Bar-Or
authors.forename: David
authors.initials: D
authors.lastname: Bar-Or
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003120:Colorado; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006764:Hospitals, Community; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015999:Multivariate Analysis; D010360:Patient Transfer; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers / Q000145:classification*; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*