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Trauma Centers not all Equal

COLUMBUS, Ohio -- Patients have a better chance of surviving life-threatening injuries if they're treated at a Level I trauma center than a Level II trauma center, according to a study by local experts.

Patients whose injuries were caused in car crashes, fires or criminal activity might not know the difference between the two, but trauma experts say the data suggest that outcome can depend on where they are taken.

The authors credit the better Level I outcomes to the increased patient volume -- at least 1,200 admissions a year -- required of such centers. Level II centers have no volume requirement.

In medicine, the more you perform, the better you get.

The study, recently published in the Journal of Trauma, looked at the outcomes of 18,103 injured adult patients taken to Level I and II trauma centers by emergency medical workers between January 2003 and December 2006.

Physicians at Ohio State University Medical Center did the research and found that although Level I centers received patients with more severe injuries and more complications, those patients had better outcomes than those taken to Level II centers.

Authors say this is the first time Ohio Trauma Registry data have been analyzed to compare patient outcomes at the two kinds of trauma centers.

Trauma experts say critically injured patients fare better when matched with hospitals best staffed and equipped to treat them. State law requires that these patients be taken to trauma centers verified by the American College of Surgeons.

Level I and II centers have similar requirements and, for the most part, receive similar patients.

"We assume if hospitals meet certain standards, the outcome is good," said Dr. Steve M. Steinberg, director of critical care, trauma and burns at OSU Medical Center and co-author of the study.

"Our intent is to determine if that is true or not."

According to the study, patients taken to Level I centers had better survival rates and were more likely to be discharged rather than sent to rehabilitation centers.

There are 11 adult Level I trauma centers in Ohio, including Ohio State and Grant Medical Center. There also are 11 Level II trauma centers in the state, including Mount Carmel West hospital and Riverside Methodist Hospital, which, like Grant, is owned by OhioHealth.

Last year, OSU Medical Center treated 1,459 trauma patients; Grant, 3,447; Riverside, 2,043; and Mount Carmel, 929.

The study found, for example, that patients with traumatic head injuries increase their odds of survival by 34 percent by being treated at Level I centers. And for patients with pelvic fractures, the odds of surviving improve by 51 percent at Level I centers.

The study also found that patients with penetrating injuries -- such as cuts and gunshot wounds -- are 30 percent more likely to be sent home without rehabilitation from a Level I center, as compared with a Level II center.

Dr. Marco Bonta, director of trauma services at Riverside, noted that more than 2,000 trauma patients were admitted there last year.

Bonta said lumping data from all Level II centers, no matter the location or patient volume, is a flaw of the study.

"Riverside should be compared to centers of the same size," Bonta said. "Our outcomes are good ... I'd hold them up against any of these (Level I) hospitals."

The study's authors say this research is a starting point to further examine the state's trauma system, which was created in 2003.

"This definitely opens the door to interesting questions to investigate," said Dr. Michael Cudnik, an OSU emergency room doctor and co-author of the study.

His next study will look at outcomes of just Level I trauma centers across the state.

Dr. David Keseg, medical director of the Columbus Division of Fire, said more research is needed before paramedics should consider changing their protocols.

If the EMS protocols were to change, it could be a burden for the city's two Level I centers. \ "It would be difficult for Level I trauma centers to accommodate the increased volume," said Dr. Steven Santanello, vice president of surgical and trauma services at Grant Medical Center.

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