Even though the American College of Surgeons (ACS) has a sophisticated quality improvement program in place for ACS-verified trauma centers, many injured patients were treated at non-accredited facilities. The researchers sought to look for differences in outcomes between non-trauma hospitals and identified hospitals with higher mortality rates for a study. Risk-adjusted and reliability-adjusted rates of mortality and interfacility transfer and ED length-of-stay (ED-LOS) among patients transferred from EDs were computed for each institution using Bayesian approaches. Patients above the age of more than 55 and those with lower Glasgow coma scores (GCS) were divided into subgroups. To deal with missing data, multiple imputations were performed. Mortality ranged from 0.9% to 3.1%, interfacility transfer rates ranged from 2.1% to 95.6%, and mean ED-LOS ranged from 81 to 231 minutes. High and low statistical outlier hospitals were identified for each outcome, and subgroup analysis revealed comparable hospital variance. When compared to nonmetropolitan hospitals and risk-adjusted, metropolitan hospitals were linked with higher mortality [odds ratio (OR) 1.7, P=0.004], decreased likelihood of interfacility transfer (OR 0.7, P≤0.001), and increased ED-LOS (coef. 0.1, P≤0.001). Non-trauma hospitals have a wide range of trauma outcomes. Therefore, Nontrauma hospitals should be involved in efforts to improve trauma quality by reducing variation in outcomes of injured patients treated at those facilities.
