title: Are all level I trauma centers created equal? A comparison of American College of Surgeons and state-verified centers.
abstract: Scant literature investigates potential outcome differences between Level I trauma centers. We compared overall survival and survival after acute respiratory distress syndrome (ARDS) in patients admitted to American College of Surgeons (ACS)-verified versus state-verified Level  I trauma centers. Using the National Trauma Data Bank Version 7.0, incident codes associated with admission to an ACS-verified facility were extracted and compared with the group admitted to state-verified centers. Overall, there were 382,801 (73.7%) patients admitted to ACS and 136,601 (26.3%)  admitted to state centers. There was no adjusted survival advantage after admission to either type (4.9% for ACS vs 4.8% for state centers; 1.014 [95% CI, 0.987 to 1.042], P = 0.311). However, in the 3,088 cases of ARDS, mortality for admission to the ACS centers was 20.3 per  cent (451 of 2,220) versus 27.1 per cent (235 of 868) for state centers. Adjusting for injury severity and facility size, admission to an ACS center was associated with a significantly greater survival after ARDS (0.75 [0.654 to 0.860]; P < 0.001). Level I verification does  not necessarily imply similar outcomes in all subgroups. Federal oversight may become necessary to ensure uniformity of care, maximizing outcomes across all United States trauma systems. Further study is needed.
authors: Division of Acute Care Surgery, Los Angeles County + USC Medical Center, Los Angeles, California 90033-4525, USA. usmitj02@yahoo.com
authors: Jennifer
authors: J
authors: Smith
authors: David
authors: D
authors: Plurad
authors: Kenji
authors: K
authors: Inaba
authors: Peep
authors: P
authors: Talving
authors: Lydia
authors: L
authors: Lam
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019985:Benchmarking; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult