Use of a state-wide administrative database in assessing a regional trauma system: the New York City experience

BACKGROUND: A successful regional trauma care system should concentrate severely injured patients within trauma centers, and should improve severity-adjusted outcomes. We compared injured patients' outcomes in New York City's level 1 trauma centers and nontrauma centers. STUDY DESIGN: We analyzed 1998-2000 New York Statewide Planning and Cooperative Research System (SPARCS) data for 103,725 adult discharges from 70 New York City hospitals (15 level I trauma centers), using ICD-9CM codes 800-950. Their 227 DRG's were aggregated into 7 clinical injury classes. A severity index was extracted from each refined DRG, and deaths, age, and gender were analyzed. Regression analysis predicted death from age, gender, severity index, and trauma center discharge, with separate analyses of the three largest clinical classes, and estimated excess mortality because of trauma center discharge. RESULTS: Level 1 trauma centers discharged 48.2% of injured patients, with higher mean annual discharges per hospital (1,046 discharges per TC vs. 437 per NTC, p < 0.001). Trauma centers discharged more than half the central nervous system, general/gastrointestinal, cardiothoracic, and vascular injuries. Trauma center patients were 12.5 years younger than NTC patients (p < 0.0005), and were disproportionately men (64.7% TC vs. 47.2% NTC, p < 0.0005). For the entire patient cohort, and for central nervous system, orthopaedic and general/gastrointestinal injuries, severity, age, and gender adjusted mortality risk was significantly greater at trauma centers than nontrauma centers. CONCLUSIONS: New York City's trauma system concentrates injured patients in trauma centers on the basis of injury class rather than severity, but does not produce improved adjusted mortality outcomes for injured patients.