title: Ground-level falls: 9-year cumulative experience in a regionalized trauma system.
abstract: Ground-level falls (GLFs) are the leading cause of nonfatal hospitalized injuries in the US. We hypothesized that risk-adjusted mortality would not vary between levels of trauma center verification if regional triage functioned appropriately. Data were collected from our regional trauma registry for the years 2001 through 2009. A multilevel mixed-effects logistic regression model was developed to compare risk-adjusted mortality rates by trauma center level and by year. GLF patients numbered 8202 over 9 years with 2.1% mortality. Mean age was 74.5 years and mean probability of death was 0.021 (95% confidence interval [CI], 0.020-0.021). The level I center-treated patients had the highest probability of death (0.033) compared to levels II and III/IV patients (0.023 and 0.018, respectively; P < 0.001), with the highest mortality (6.0%, 3.1%, and 1.1% for levels I, II, and III/IV; P < 0.001). The adjusted odds ratio of mortality was lowest at the level I center (0.71; 95% CI, 0.56-0.91), while no difference existed between level II (1.17; 95% CI, 0.90-1.51) and level III/IV centers (1.22; 95% CI, 0.90-1.66). The 95% CIs for risk-adjusted mortality by year overlapped the 1.0 reference line for each year from 2002 to 2009. In conclusion, regional risk-adjusted mortality for GLF has varied little since 2002. More study is warranted to understand the lower risk-adjusted GLF mortality at the level I center for this growing patient population.
authors.affiliation: Division of Trauma, Department of Surgery, Baylor University Medical Center at Dallas (Cook); Department of Family Medicine, University of Texas Health Science Center, Tyler, Texas (Cade); Departments of Emergency Medicine (King) and Trauma Surgery (Berne), East Texas Medical Center, Tyler, Texas; Department of Trauma Services, Trinity Mother Frances Health System, Tyler, Texas (Fernandez); and Department of Trauma Surgery, Regional Medical Center Bayonet Point, Hudson, Florida (Norwood).
authors.forename: Alan
authors.initials: A
authors.lastname: Cook
authors.forename: Angela
authors.initials: A
authors.lastname: Cade
authors.forename: Brad
authors.initials: B
authors.lastname: King
authors.forename: John
authors.initials: J
authors.lastname: Berne
authors.forename: Luis
authors.initials: L
authors.lastname: Fernandez
authors.forename: Scott
authors.initials: S
authors.lastname: Norwood