Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: A systematic review and meta-analysis

Introduction Identifying patients who can be safely managed in lower-level trauma centers is critical to avoid overburdening level I centers. This study examines the transfer patterns and outcomes of blunt splenic injury (BSI) patients cared for at 2 regional level III trauma centers as compared to an associated level I center. Methods A retrospective cohort study was conducted including all trauma patients with BSI admitted to 2 level III trauma centers (TC3) and a level I center (TC1) between 2012 and 2022. Patients were broken into 3 categories: TC1, TC3, and transfer patients (transferred from TC3 to TC1). Results A total of 1480 patients were admitted to TC1, 208 patients to TC3, and 128 were transferred. 22.7% of transfer patients were children. No difference in splenic injury grade was seen between patients managed at TC1 and TC3. Patients presenting to TC1 had more severe concomitant injuries. Patients underwent urgent splenectomy at similar rates at TC1 and TC3 (15.1 vs 18.7%, P = .1). Successful nonoperative management was achieved at similar rates (81.3 vs 75.5%, P = .1). When controlling for ISS and ED disposition, there was no significant difference in length of stay (LOS), ICU LOS, and inpatient mortality between TC1 and TC3. Conclusion Level III centers effectively managed BSI achieving comparable outcomes to the level 1 center. Transfers commonly occurred in pediatric and multisystem trauma patients, though high-grade splenic injuries were not predictive of transfer. High-grade BSI can be safely managed at level III centers without need for transfer.

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Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: A systematic review and meta-analysis

Abstract: Top levels of trauma care are associated with improved survival for major trauma patients. This has been reproduced when combining populations with specific injuries. See link below. #major trauma center #critical care #outcome assessment

Cited by 5 publications

References 70 publications

Identifying the severely injured benefitting from a specific level of trauma care in an inclusive network: A multicentre retrospective study

Identifying the severely injured benefitting from a specific level of trauma care in an inclusive network: A multicentre retrospective study

Implementation of the Modified Brain Injury Guidelines Might Be Feasible and Cost-Effective Even in a Nontrauma Hospital

Level III Trauma Centers Achieve Comparable Outcomes in Blunt Splenic Injury as Level I Centers

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