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 language | English (US) |
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Pages (from-to) | 435-458 |
Number of pages | 24 |
Journal | Health Services Research |
Volume | 40 |
Issue number | 2 |
DOIs | |
State | Published - Apr 2005 |
Keywords
- Injury severity scale
- Instrumental variables
- Quality of care
- Trauma centers
ASJC Scopus subject areas
- Health Policy