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January 25, 2006

Trauma-Center Care Significantly Lowers Risk of Death

Ellen J. MacKenzie

Care at a trauma center lowers by 25 percent the risk of death for injured patients compared to treatment received at non-trauma centers, according to the results of a nationwide study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of Washington School of Medicine. “A National Evaluation of the Effect of Trauma Center Care on Mortality,” to be published in the January 26, 2006, edition of the New England Journal of Medicine, is among the first studies to provide strong evidence of the effectiveness of specialized trauma-care facilities.

“Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. Now we have conclusive data to show that trauma care is effective,” said the study’s lead author, Ellen J. MacKenzie, PhD, professor and chair of the Department of Health Policy and Management at the Bloomberg School of Public Health. “The findings of this study argue strongly for continued efforts at regionalizing trauma care at the state and local levels to assure that patients who suffer serious injuries get to a trauma center where they are afforded the best possible care.”

The National Study on the Costs and Outcomes of Trauma analyzed the outcomes of 5,190 adult trauma patients who received treatment at 18 level 1 trauma centers (the highest level of care) and 51 non-trauma centers. The researchers also analyzed the characteristics of each hospital, such as the number of patients treated and types of specialty services available.

After adjusting for factors such as severity of injury, patient age and pre-existing medical conditions, the researchers found a 25 percent overall decrease in the risk of death following care in a trauma center compared to receiving care at a non-trauma center. The adjusted in-hospital death rate was 7.6 percent for patients treated at trauma centers compared to 9.5 percent for patients treated at non-trauma facilities. The mortality rate one year following the injury was 10.4 percent for patients at trauma centers compared to 13.8 percent for patients at non-trauma centers.

The researchers noted that the effect of treatment at trauma centers was less significant among older patients with underlying health problems.

“This study provides convincing evidence that care at a level 1 trauma center saves lives,” said Gregory Jurkovich, MD, a University of Washington professor of surgery and a co-author of the study. “Our next step is to see if level 1 trauma center care also improves the quality of life of trauma survivors. We’ll examine the differences in functional outcome and cost of care between level 1 trauma centers and non-trauma centers.”

Caring for the acutely injured is a major public health issue and involves bystanders and community members, health care professionals and health care systems. “This research provides state and community leaders with crucial information, so that they can make sound decisions regarding their trauma systems and the care that people receive after they are injured. It is one way that the Centers for Disease Control and Prevention contributes to reducing premature death and disability through research and partnerships,” said Richard C. Hunt, MD, director of the CDC’s Injury Center’s Division of Injury Response.

Funding for the study was provided by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control and the National Institutes of Health’s National Institute on Aging.

Additional study authors are Frederick P. Rivara, MD, MPH, and Avery B. Nathens, MD, PhD, from the University of Washington School of Medicine; and Katherine P. Frey, MPH, Brian L. Egleston, MPP, David S. Salkever, PhD, and Daniel O. Scharfstein, ScD, from the Johns Hopkins Bloomberg School of Public Health.

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Kenna Lowe or Tim Parsons at 410-955-6878 or paffairs@jhsph.edu. Photographs of Ellen MacKenzie are available upon request.