title: Compliance with recommended care at trauma centers: association with patient outcomes.
abstract: BACKGROUND
  State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality.
  
  
  METHODS
  This retrospective observational study was conducted at 5 Level I trauma centers across the country. Participants were adult patients with moderate to severe injuries (n = 3,867). The association between compliance with 22 commonly recommended clinical practices and in-hospital mortality was measured after adjusting for patient demographics and injuries and their severity.
  
  
  RESULTS
  Compliance with individual clinical practices ranged from as low as 12% to as high as 94%. After adjusting for patient demographics and injury severity, each 10% increase in compliance with recommended care was associated with a 14% reduction in the risk of death. Patients who received all recommended care were 58% less likely to die (odds ratio = 0.42; 95% CI, 0.28-0.62) compared with those who did not.
  
  
  CONCLUSIONS
  Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality.
authors.affiliation: Baylor Health Care System, Dallas, TX. Electronic address: shahid.shafi@baylorhealth.edu.
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.affiliation: Baylor Health Care System, Dallas, TX.
authors.forename: Sunni A
authors.initials: SA
authors.lastname: Barnes
authors.affiliation: Baylor Health Care System, Dallas, TX; INTEGRIS Health, Oklahoma, OK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Rayan
authors.affiliation: Baylor Health Care System, Dallas, TX.
authors.forename: Rustam
authors.initials: R
authors.lastname: Kudyakov
authors.affiliation: Baylor Health Care System, Dallas, TX.
authors.forename: Michael
authors.initials: M
authors.lastname: Foreman
authors.affiliation: University of California Los Angeles, Los Angeles, CA.
authors.forename: H Gil
authors.initials: HG
authors.lastname: Cryer
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
authors.affiliation: St Luke's University Hospital, Bethlehem, PA.
authors.forename: William
authors.initials: W
authors.lastname: Hoff
authors.affiliation: University of Texas Medical School at Houston, Houston, TX.
authors.forename: John
authors.initials: J
authors.lastname: Holcomb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000401:mortality / Q000628:therapy; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy; D005260:Female; D050723:Fractures, Bone / Q000401:mortality / Q000628:therapy; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010388:Pelvis / Q000293:injuries; D012042:Registries; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000592:standards*; D014481:United States / Q000453:epidemiology