title: Association Between Hospital Trauma Designation and Maternal and Neonatal Outcomes after Injury among Pregnant Women in Washington State.
abstract: BACKGROUND
  Approximately 8% of all pregnant women experience a traumatic injury during pregnancy. There has been no evaluation of a state trauma system's effect on birth outcomes. This study examined the association of treatment in a designated trauma hospital vs a nontrauma hospital on maternal and neonatal outcomes among injured pregnant patients in Washington State.
  
  
  METHODS
  We conducted a population-based retrospective cohort study (1995 to 2012). The Washington State Birth Events Records Database and the Comprehensive Hospital Abstract Recording System were linked to ascertain all hospitalized injured pregnant patients. The cohort was dichotomized by exposure to trauma vs nontrauma hospitals. We analyzed the association between trauma hospital designation and risk of adverse birth outcomes using logistic regression to estimate odds ratios and 95% CI, adjusting for Injury Severity Score and other confounders.
  
  
  RESULTS
  We ascertained 3,429 injured pregnant women. Patients treated in trauma hospitals had an adjusted odds ratio (aOR) of 0.60 (95% CI, 0.50-0.73) for preterm labor, aOR = 0.74 (95% CI, 0.57-0.96) for gestational age <37 weeks, aOR = 0.72 (95% CI, 0.54-0.97) for birth weight <2,500 g, and aOR = 0.54 (95% CI, 0.39-0.76) for meconium at delivery. No statistically significant associations were found for maternal death (aOR = 2.57; 95% CI, 0.32-20.38), fetal death (aOR = 1.60; 95% CI, 0.35-7.35), or neonatal death (aOR = 1.50; 95% CI, 0.50-4.49).
  
  
  CONCLUSIONS
  Treatment of injured pregnant women at designated trauma hospitals was associated with several improved birth outcomes. Trauma hospital treatment, with a greater focus on maternal resuscitation and monitoring, might explain these findings.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA; Department of Preventive Medicine, Madigan Army Medical Center, Tacoma, WA. Electronic address: john.t.distelhorst.mil@mail.mil.
authors.forename: John T
authors.initials: JT
authors.lastname: Distelhorst
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Krishnamoorthy
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Schiff
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005313:Fetal Death / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D066087:Perinatal Death / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000628:therapy*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014861:Washington; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*; D055815:Young Adult