title: The impact of American College of Surgeons trauma center designation and outcomes after early thoracotomy: a National Trauma Databank analysis.
abstract: Trauma centers are designated by the American College of Surgeons (ACS) into four different levels based on resources, volume, and scientific and educational commitment. The purpose of this study was to evaluate the relationship between ACS center designation and outcomes after early  thoracotomy for trauma. The National Trauma Databank (v. 7.0) was used to identify all patients who required early thoracotomy. Demographics, clinical data, and outcomes were extracted. Patients were categorized according to ACS trauma center designation. Multivariate logistic regression was  used to evaluate the impact of ACS trauma center designation on mortality. From 2002 to 2006, 1834 (77.4%) patients were admitted to a Level I ACS verified trauma center, 474 (20.0%) to a Level II, and 59 (3.6%) to a Level III/IV facility. After adjusting for differences between the groups,  there were no significant differences in mortality (overall: 53.3% for Level I, 63.1% for Level II, and 52.5% for Level III/IV, adjusted P = 0.417; or for patients arriving in cardiac arrest: 74.9% vs 87.1% vs 85.0%, P = 0.261). Subgroup analysis did not show any  significant difference in survival irrespective of mechanism of injury. Glasgow Coma Scale score ≤ 8, Injury Severity Score > 16, no admission systolic blood pressure, time from admission to thoracotomy, and nonteaching hospitals were found to be independent predictors of death. For  trauma patients who have sustained injuries requiring early thoracotomy, ACS trauma center designation did not significantly impact mortality. Nonteaching institutions however, were independently associated with poorer outcomes after early thoracotomy. These findings may have important implications  in educational commitment of institutions. Further prospective evaluation of these findings is warranted.
authors.affiliation: Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. bukurm@cshs.org
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Bernardino
authors.initials: B
authors.lastname: Castelo Branco
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Ramon
authors.initials: R
authors.lastname: Cestero
authors.forename: Leslie
authors.initials: L
authors.lastname: Kobayashi
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy / Q000401:mortality / Q000592:standards*; D014193:Trauma Centers / Q000592:standards*; D014481:United States