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We computed pooled summary estimates using random-effects meta-analysis. The primary outcome was in-hospital mortality secondary outcomes included adverse events, resource use and processes of care. Comparison groups comprised nonverified trauma centres, or the same centre before it was first verified or re-verified. The intervention was trauma centre verification. Our population consisted of injured patients treated at trauma centres. We conducted a systematic search of the CINAHL, Embase, HealthStar, MEDLINE and ProQuest databases, as well as the websites of key injury organizations for grey literature, from inception to June 2019, without language restrictions. This systematic review aimed to synthesize available evidence on the effectiveness of trauma centre verification.
THEN WE ALL FALL FALL FALL VERIFICATION
There is a growing trend toward verification of trauma centres, but its impact remains unclear. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability. Differential O:E for ACS III/IV and State III/IV centers suggests that factors beyond case mix alone influence outcomes for GLF patients. Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Mortality was 4.21% overall with a three-fold increase for those aged 60 y and older versus younger than 60 y (4.93% versus 1.46%, P < 0.001). Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques.Īnalysis of 812,053 patients' data revealed the proportion of GLF in the National Trauma Data Bank increased 8.7% (14.1%-22.8%) over the 8 y studied. 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. This retrospective cohort study used National Trauma Data Bank files for 2007-2014. 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.
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Trauma center levels define tiers of capability to treat injured patients. Ground-level falls (GLFs) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity, and physiologic derangement.