Does Trauma Center Volume Account for the Association Between Trauma Center Verification Level and In-Hospital Mortality among Children Injured by Firearms in California?

Gwyneth A. Sullivan*, Susheel Reddy, Audra J. Reiter, Suhail Zeineddin, Michael Visenio, Andrew Hu, Robert MacKersie, Rashmi Kabre, Mehul V. Raval, Anne M. Stey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: Heterogeneity in trauma center designation and injury volume offer possible explanations for inconsistencies in pediatric trauma center designation's association with lower mortality among children. We hypothesized that rigorous trauma center verification, regardless of volume, would be associated with lower firearm injury-associated mortality in children. STUDY DESIGN: This retrospective cohort study leveraged the California Office of Statewide Health Planning and Development patient discharge data. Data from children aged 0 to 14 years in California from 2005 to 2018 directly transported with firearm injuries were analyzed. American College of Surgeons (ACS) trauma center verification level was the primary predictor of in-hospital mortality. Centers' annual firearm injury volume data were analyzed as a mediator of the association between center verification level and in-hospital mortality. Two mixed-effects multivariable logistic regressions modeled in-hospital mortality and the estimated association with center verification while adjusting for patient demographic and clinical characteristics. One model included the center's firearm injury volume and one did not. RESULTS: The cohort included 2,409 children with a mortality rate of 8.6% (n = 206). Adjusted odds of mortality were lower for children at adult level I (adjusted odds ratio [aOR] 0.38, 95% CI 0.19 to 0.80), pediatric (aOR 0.17, 95% CI 0.05 to 0.61), and dual (aOR 0.48, 95% CI 0.25 to 0.93) trauma centers compared to nontrauma/level III/IV centers. Firearm injury volume did not mediate the association between ACS trauma center verification and mortality (aOR/10 patient increase in volume 1.01, 95% CI 0.99 to 1.03). CONCLUSIONS: Trauma center verification level, regardless of firearm injury volume, was associated with lower firearm injury-associated mortality, suggesting that the ACS verification process is contributing to achieving optimal outcomes.

Original languageEnglish (US)
Pages (from-to)738-749
Number of pages12
JournalJournal of the American College of Surgeons
Volume237
Issue number5
DOIs
StatePublished - Nov 1 2023

Funding

Dr Reddy receives salary support from the NIH. Dr Visenio is supported by the NIH. Dr Stey is supported by the American Association for the Surgery of Trauma, The American College of Surgeons and the NIH/National Heart Lung and Blood Institute (K23HL157832-01). Support: Dr Reddy receives salary support from the NIH. Dr Visenio is supported by the NIH. Dr Stey is supported by the American Association for the Surgery of Trauma, The American College of Surgeons and the NIH/National Heart Lung and Blood Institute (K23HL157832-01).

ASJC Scopus subject areas

  • General Medicine

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