Association for Public Policy Analysis & Management

Background: Previous Studies have shown that trauma center designation of level 1 is associated with improved patient outcomes. However, most studies are cross-sectional, focus on volume related issues and are direct comparison between levels. This study investigates the change of characteristics after transition and whether patients receive the same level of outcome during the initial period of transition.

Methods: We performed a retrospective cohort study that analyzed hospital and patient records included in the National Trauma Data Bank from years 2007-2016. Patient characteristics were compared before and after transition. Mortality, transfer rate, complications, and lengths of stay more than 7 days were obtained from multilevel logistic regression model, comparing post-transition year with well-established trauma centers. Difference-in-differences model also evaluated the temporal relationship between outcome and trauma center designation after matching.

Results: 9 trauma centers transitioned from level 2 to level 1 during 2007-2016. 72 level 1 trauma centers were identified as well-established unchanged during the 10 year-period. After transition, patient characteristics showed a difference of the distribution of race, injury severity scores, injury mechanisms, comorbidities, and traumatic brain injuries. Comparing first year of transition with well-established, penetrating trauma patients showed higher risk of complications among the transitioned trauma centers. Difference-in-differences model also showed a difference in complication risk between the transitioned and well-established in respect of time.

Conclusions: During the initial period of transition, care of penetrating trauma patients had a higher complication risk with odds ratio of 4.66 (p value=0.02). No statistical difference of mortality, ICU transfers, and length of stay after transition compared to well-established.