Do trauma centers improve functional outcomes: A National Trauma Databank analysis?

Ram Nirula, Karen Brasel

Research output: Contribution to journalArticle

39 Scopus citations


BACKGROUND: The development of a tiered trauma care system has lead to improved survival for the critically injured. The question as to whether the increased survival associated with the establishment of tiered levels of trauma care is paralleled by an improved functional outcome has not, however, been addressed. METHODS: Multivariate logistic regression analysis of the National Trauma Data Bank from 1994 to 2001 was performed with functional independence measure (FIM) as the primary outcome. Trauma centers were dichotomized as Level II or above versus Level III or below. Blunt and penetrating trauma patients were analyzed separately. Other covariates included age, gender, shock, comorbidities, alcohol, drugs, as well as head, chest, abdominal, spine, and lower extremity injury. Confidence intervals were set at an alpha of 0.05. RESULTS: A total of 474,024 patients were analyzed. Among minimally injured penetrating trauma patients, those receiving care at a higher tiered center had a higher likelihood of total independence (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.0, 2.0). Among minimal, moderate and severely injured blunt trauma patients those receiving care at a higher tiered center had a higher likelihood of total independence (OR = 1.2, 95% CI = 1.0, 1.4, OR = 1.3, 95% CI = 1.1, 1.6, OR = 1.3, 95% CI = 1.3, 1.5, respectively). CONCLUSIONS: These data indicate that the complex care delivered by advanced level trauma centers is associated with improved functional outcomes. Further investigations to identify the reasons for differences in these outcomes are necessary to improve care at lower tiered hospitals particularly for minimally injured patients.

Original languageEnglish (US)
Pages (from-to)268-271
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number2
StatePublished - Aug 1 2006



  • Blunt
  • Functional outcome
  • Injury
  • Penetrating
  • Trauma center

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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