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Trauma center level impacts survival for cirrhotic trauma patients.
- Source :
-
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2013 Apr; Vol. 74 (4), pp. 1133-7. - Publication Year :
- 2013
-
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.<br />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.<br />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).<br />Conclusion: 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.<br />Level of Evidence: Epidemiologic study, level III.
- Subjects :
- Female
Hospital Mortality trends
Humans
Injury Severity Score
Liver Cirrhosis mortality
Male
Middle Aged
Odds Ratio
Risk Factors
Survival Rate trends
United States epidemiology
Wounds and Injuries complications
Liver Cirrhosis complications
Trauma Centers organization & administration
Wounds and Injuries mortality
Subjects
Details
- Language :
- English
- ISSN :
- 2163-0763
- Volume :
- 74
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The journal of trauma and acute care surgery
- Publication Type :
- Academic Journal
- Accession number :
- 23511156
- Full Text :
- https://doi.org/10.1097/TA.0b013e3182858a59