Factors associated with hospital mortality in traumatic injuries: incentive for trauma care integration.

Objectives: The main aim of this study was to contrast the variation in mortality between trauma centres (TCs) and non-trauma hospitals (NTHs) in Texas, and among TCs by sociodemographic and economic factors of trauma cases.

Study Design: Difference in fatality due to trauma by hospital type was studied for all injured cases hospitalized over a 2-year period.

Methods: The outcome measure was mortality following an injury for cases that survived the impact and were treated in any hospital. Logistic regressions were employed to compare the risk factors associated with trauma fatalities between TCs and NTHs, and among TCs.

Results: The risk of dying at a TC in contrast to an NTH was higher among young adult males and cases admitted through the emergency department/room. In rural areas, fatality was higher among 25-44 year olds, Hispanics, uninsured patients, and cases admitted through transfer. In urban settings, fatality was higher among 18-24 year olds, patients covered by 'other' insurance, and cases admitted as severe emergencies. Increased mortality at Level I TCs occurred due to the transfer of patients from rural areas. Blacks and Hispanics in rural areas were more likely to die, while Hispanics had lower fatality in Level I TCs in urban areas. Survival time was longer for patients treated in urban TCs compared with rural TCs.

Conclusion: In the absence of validated data about severity of cases and type of injury, and details about the treatment provided to trauma cases in this study, more investigation is needed into the case-mix of trauma patients admitted to TCs and NTHs. Further exploration is necessary for better co-ordination of the emergency care response to integrate NTHs within the trauma system and alleviate the stress placed on Level I TCs. Revisiting the transfer algorithms could improve clinical outcomes, particularly when TCs are closed due to diversion protocols.