WINSTON-SALEM, N.C. – A national study that included six hospitals in North Carolina has found that the overall risk of death is 25 percent lower when care for traumatic injuries is provided at trauma centers, compared to hospitals without trauma centers.
Trauma centers have the equipment and on-site medical personnel to treat life-threatening injuries 24 hours a day. The study included 18 hospitals with level 1 trauma centers and 51 hospitals without trauma centers, located in 14 states.
"The research reinforces the importance of trauma care and the development of trauma systems," said Wayne Meredith, M.D., director of the Division of Surgical Sciences at Wake Forest University Baptist Medical Center. Meredith, a trauma surgeon,was on the study's advisory committee and chairs a committee of the American College of Surgeons that establishes criteria to certify trauma centers.
The study, known as the National Study on the Costs and Outcomes of Trauma, was reported in this week's New England Journal of Medicine. It included 5,191 patients with moderate to severe injuries. Researchers reviewed medical records to analyze the injuries that were related to risk of death.
They found that within one year after injury, the rate of death was significantly lower when care has been provided in trauma centers (10.4 percent versus 13.8 percent for non-trauma centers). The difference was similar for rate of in-hospital death. The differences were most pronounced when patient injuries were severe, the researchers said.
The authors said that though there wasn't enough evidence to establish a hospital-based effect among patients with lesser injuries, it is possible that treatment at a trauma center could benefit those patients by reducing complications and increasing the likelihood that they will return to productivity.
"The results show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization," wrote the authors.
Many states use the American College of Surgeons' trauma center criteria to designate trauma centers based on a regional approach. In some states, however, there are few if any trauma centers because they are expensive to maintain, and before the study, there was no strong evidence of their effectiveness.
North Carolina has five level 1 trauma centers -- at Wake Forest Baptist, Duke, Carolinas Medical Center, UNC and Pitt County Memorial Hospital (ECU). Wake Forest Baptist operates the state's only level 1 trauma center for pediatrics. Wake Forest Baptist handles the state's most severe trauma cases according to trauma discharge data.
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