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

Kenneth (John) McConnell, Craig Newgard, Richard Mullins, Melanie Arthur, Jerris R. Hedges

Research output: Contribution to journalArticle

81 Citations (Scopus)

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)435-457
Number of pages23
JournalHealth Services Research
Volume40
Issue number2
DOIs
StatePublished - Apr 2005

Fingerprint

Trauma Centers
trauma
mortality
Head
Mortality
Craniocerebral Trauma
Information Storage and Retrieval
Wounds and Injuries
statistical method
Hospital Emergency Service
Cohort Studies
Retrospective Studies
confidence
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Mortality benefit of transfer to level I versus level II trauma centers for head-injured patients. / McConnell, Kenneth (John); Newgard, Craig; Mullins, Richard; Arthur, Melanie; Hedges, Jerris R.

In: Health Services Research, Vol. 40, No. 2, 04.2005, p. 435-457.

Research output: Contribution to journalArticle

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