Mortality benefit of transfer to level I versus level II trauma centers for head-injured patients

K. John McConnell, Craig D. Newgard, Richard J. Mullins, Melanie Arthur, Jerris R. Hedges

Research output: Contribution to journalArticle

84 Scopus citations

Abstract

Objective. To determine whether head-injured patients transferred to level I trauma centers have reduced mortality relative to transfers to level II trauma centers. Data Source/Study Setting. Retrospective cohort study of 542 patients with head injury who initially presented to 1 of 31 rural trauma centers in Oregon and Washington, and were transferred from the emergency department to 1 of 15 level I or level II trauma centers, between 1991 and 1994. Study Design. A bivariate probit, instrumental variables model was used to estimate the effect of transfer to level I versus level II trauma centers on 30-day postdischarge mortality. Independent variables included age, gender, Injury Severity Scale (ISS), other indicators of injury severity, and a dichotomous variable indicating transfer to a level I trauma center. The differential distance between the nearest level I and level II trauma centers was used as an instrument. Principal Findings. Patients transferred to level I trauma centers differ in unmeasured ways from patients transferred to level II trauma centers, biasing estimates based on standard statistical methods. Transfer to a level I trauma center reduced absolute mortality risk by 10.1% (95% confidence interval 0.3%, 22.2%) compared with transfer to level II trauma centers. Conclusions. Patients with severe head injuries transferred from rural trauma centers to level I centers are likely to have improved survival relative to transfer to level II centers.

Original languageEnglish (US)
Pages (from-to)435-458
Number of pages24
JournalHealth Services Research
Volume40
Issue number2
DOIs
StatePublished - Apr 2005

Keywords

  • Injury severity scale
  • Instrumental variables
  • Quality of care
  • Trauma centers

ASJC Scopus subject areas

  • Health Policy

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