Longitudinal analysis of the impact of a level 1 trauma center designation at a university hospital

Background: There have been no quantitative, longitudinal studies on the effect of Level 1 Trauma Center (TC) designation on a facility. The purpose of this study was to evaluate the impact of such designation. Study Design: In September 1990, a 416-bed core affiliate hospital of the state medical school system was state-designated as the Level 1 TC for 6 counties. Data collected from five concurrent 1-year periods after TC designation included case number and acuity of condition, length of hospital and ICU stays, preventable death rates, financial coverage, and neurosurgery and orthopaedic volume. No registry data were available before TC designation. Results: While the yearly number of cases remained stable, the overall severity of cases increased coincident with a 50% reduction in overtriage. The need for ICU services increased over 50%. Mean Injury Severity Score increased from 11.0 in year 1 to 13.8 in year 5. There was a 25% to 30% increase in severe neurosurgery injuries and in major orthopaedic trauma. There was no change in the “self-pay” financial category (12% to 16%) or the ratio of blunt to penetrating trauma (90:10). Conclusions: With Level 1 TC designation in a noninner city setting, planners can expect a shift to more severely injured patients, but should not expect an increase in nonpaying patients. Increases in severe injuries will continue to place strain on the ICU. Impact on neurosurgeons and orthopaedic surgeons mandates their support in TC planning.