Does the halo effect for level 1 trauma centers apply to high-acuity nonsurgical admissions?

Ann E. Hwalek, Anai N. Kothari, Elizabeth H. Wood, Barbara A. Blanco, McKenzie Brown, Timothy P. Plackett*, Paul C. Kuo, Joseph Posluszny

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Context: The halo effect describes the improved surgical outcomes at trauma centers for nontrauma conditions. Objective: To determine whether level 1 trauma centers have improved inpatient mortality for common but high-acuity nonsurgical diagnoses (eg, acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia [PNA]) compared with non–level 1 trauma centers. Methods: The authors conducted a population-based, retrospective cohort study analyzing data from the Healthcare Cost and Utilization Project State Inpatient Database and the American Hospital Association Annual Survey Database. Patients who were admitted with AMI, CHF, and PNA between 2006-2011 in Florida and California were included. Level 1 trauma centers were matched to non–level 1 trauma centers using propensity scoring. The primary outcome was risk-adjusted inpatient mortality for each diagnosis (AMI, CHF, or PNA). Results: Of the 190,474 patients who were hospitalized for AMI, CHF, or PNA, 94,037 patients (49%) underwent treatment at level 1 trauma centers. The inpatient mortality rates at level 1 trauma centers vs non–level 1 trauma centers for patients with AMI was 8.10% vs 8.40%, respectively (P=.73); for patients with CHF, 2.26% vs 2.71% (P=.90); and for patients with PNA, 2.30% vs 2.70% (P=.25). Conclusion: Level 1 trauma center designation was not associated with improved mortality for high-acuity, nonsurgical medical conditions in this study.

Original languageEnglish (US)
Pages (from-to)303-309
Number of pages7
JournalJournal of the American Osteopathic Association
Issue number5
StatePublished - May 2020


  • Halo effect
  • Inpatient mortality
  • Nonsurgical medical conditions
  • Trauma center

ASJC Scopus subject areas

  • Complementary and alternative medicine


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