Trauma center designation and the decreasing incidence of post-traumatic acute respiratory distress syndrome: a potential guidepost for quality improvement.
BACKGROUND
The incidence of post-traumatic acute respiratory distress syndrome (ARDS) is decreasing. We hypothesized that disparities exist in the overall incidence and incidence of ARDS over time across different types of trauma centers.


METHODS
The National Trauma Databank version 7.0 was queried for patients admitted to designated trauma centers (I-III) and ventilated at least 48 hours. Level I university admissions (group 1) were compared with level I community and level II/III center admissions (group 2).


RESULTS
There were 43,664 patients with an incidence of ARDS of 5.2% (2,260) overall, 4.1% (1,062/25,937) in group 1, and 6.8% (1,198/17,727) in group 2 (P < .001). The incidence decreased significantly in group 1 in contrast to group 2 yearly. The incidence in level I community centers was marked (608/5,180 [11.7%]) and increased significantly over time. On logistic regression, admission to a level I university center (.646 [.590-.707],<.001) was independently associated with ARDS.


CONCLUSIONS
Admission to a level I center may not necessarily confer similar results reflecting potential variation in management between centers that presumably provide similar service. These investigations may have significance to quality improvement.
Harbor-UCLA Medical Center, Torrance, CA 90033, USA. plurad@usc.edu
David S
DS
Plurad
Scott
S
Bricker
Peep
P
Talving
Lydia
L
Lam
Demetrios
D
Demetriades
D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D058996:Quality Improvement; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult