Association Between Trauma Center Designation Levels and Survival of Patients With Motor Vehicular Transport Injuries in the United States

Abstract Background Motor vehicular transport (MVT) is a leading cause of injuries globally. Health care regionalization aims at improving patients’ outcomes. Objectives This study examines the association between trauma center designation levels in the United States and survival of patients with MVT-related injuries. Methods We used the National Trauma Data Bank 2015 dataset for this retrospective study. We conducted descriptive and bivariate analyses. This was followed by a multivariate analysis to assess the association between trauma center level and survival to hospital discharge. Results One hundred sixty-eight thousand five hundred twenty-four patients were included in this study. The mean age was 39.9 years (±19.5 years) with a male predominance (63.8%). Most patients were taken to level I (55.7%) and level II (35.9%) centers. The overall survival of patients with MVT injuries was 95.3%. Involved patients were occupant (64.8%), motorcyclist (17.3%), and pedestrian (12.7%). After adjusting for confounders, patients sustaining MVT injuries who were taken to level II and III trauma centers were less likely survive compared with those taken to level I centers (odds ratio = 0.89 [95% confidence interval 0.81–0.97] and odds ratio = 0.70 [95% confidence interval 0.59–0.82], respectively). Conclusions In this study, we identified a survival benefit for patients with MVT injuries when treated at level I compared with level II and III centers. These findings provide additional evidence for the benefit of health care regionalization in the form of trauma center level designation.