title: Trauma center level impacts survival for cirrhotic trauma patients.
abstract: BACKGROUND
  Cirrhosis is known to be a significant risk factor for morbidity and mortality following trauma such that its presence is a requirement for trauma center transfer. The impact of trauma center level on post-injury survival in cirrhotic patients has not been well studied.
  
  
  METHODS
  The National Trauma Databank (version 7) was used to identify patients admitted with cirrhosis as a preexisting comorbidity. Patients who were dead on arrival, died in the emergency department, or had missing trauma center information were excluded. Our primary outcome measure was overall mortality stratified by admission trauma center level. Logistic regression analysis was used to derive adjusted mortality results.
  
  
  RESULTS
  A total of 3,395 patients met inclusion criteria (0.16% of all National Trauma Databank patients). Patients admitted to a Level I center were more likely to be younger and minorities, experience penetrating injuries, and require immediate operative intervention despite similar Injury Severity Scores (ISS). Overall mortality was lower at Level I centers compared with other centers (10.3% vs. 14.0%, p = 0.001). After logistic regression, Level I centers were associated with significantly lower mortality compared with non-Level I centers (adjusted odds ratio, 0.70; 95% confidence interval, 0.53-0.89; p = 0.004).
  
  
  CONCLUSIONS
  The mortality for cirrhotic patients admitted to a Level I trauma center was significantly less compared with those admitted to non-Level I centers. The etiology of this improved outcome needs to be identified and transmitted to non-Level I centers.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. bukurm@cshs.org
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Seth I
authors.initials: SI
authors.lastname: Felder
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Singer
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality*