Then We All Fall Down: Fall Mortality by Trauma Center Level

Abstract Background Ground-level falls (GLF) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. Materials and Methods This retrospective cohort study utilized National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Results Analysis of 812,053 patients’ data revealed the proportion of GLF in the NTDB increased 8.7% (14.1% to 22.8%) over the eight years studied. Mortality was 4.21% overall with a three-fold increase for those 60 and older versus younger than 60 (4.93% vs. 1.46%, p