750 is Higher-Level Trauma Centre Care Associated with Better Outcomes in Patients Injured by Low-Energy Trauma? A Systematic Review

Aims/Objectives/BackgroundGlobally, trauma is a significant cause of morbidity and mortality globally. In high-income countries the demographic of major trauma is changing. Trauma patients are becoming older, more likely to have multiple comorbidities, and are being injured by low-energy mechanisms, chiefly ground-level falls. It is unknown whether existing trauma systems are equipped for the optimum management of these patients. Therefore, a systematic review was performed to investigate the association between higher-level trauma centre care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma.Methods/DesignA pre-registered systematic review of all major subject databases and grey literature archives supplemented by targeted manual searching was conducted in January 2021. Where necessary study authors were contacted. In the presence of study heterogeneity a narrative synthesis was pre-specified.Abstract 750 Box 1Level 1: capable of providing total care for every aspect of injury, from prevention to rehabilitation. Level 1 centres are responsible for providing leadership in education, research, and system planning.Level 2: capable of providing initial definitive care except for particularly complex or specialised injuries.Level 3: capable of providing prompt assessment, resuscitation, stabilisation and transfer of patients when required.Level 4: provides advanced trauma life support in remote areas where no higher level of care is available.In the United Kingdom, ‘major trauma centres’ would be equivalent to a Level 1 or 2 trauma centre, and ‘trauma units’ equivalent to a Level 3 trauma centre.Results/ConclusionsOf 2,898 potentially eligible unique records, three observational studies were included. Overall the studies’ risk of bias was moderate-to-serious due to potential residual confounding and selection bias. All studies compared outcomes among adults injured by ground-level falls who were treated in American College of Surgeons (ACS) verified trauma centres in the USA. The studies demonstrated divergent results, with one demonstrating improved outcomes in level 3 or 4 trauma centres (Observed:Expected Mortality 0.973, 95%CI 0.971–0.975), one demonstrating improved outcomes in level 1 trauma centres (Adjusted Odds Ratio 0.71, 95%CI 0.56–0.91), and one demonstrating no difference between level 1 or 2 and level 3 or 4 trauma centre care (Adjusted Odds Ratio 0.91 (0.80–1.04).There is currently no clear evidence for the efficacy of major trauma centres in caring for adult patients injured by a ground-level fall. Further studies at lower risk of bias and studies conducted outwith the USA are required.