Characteristics of ACS Verified Level II and II Trauma Centers: A Study Linking Trauma Center Verification Review Data and the National Trauma Data Bank of the American College of Surgeons Committee on Trauma.

Background: The Trauma Quality Improvement Project of the American College of Surgeons (ACS) has demonstrated variations in trauma center outcomes despite similar verification status. The purpose of this study was to identify structural characteristics of trauma centers that impact patient outcomes. Methods: Trauma registry data on 361,187 patients treated at 222 ACS verified Level I and II trauma centers were obtained from the National Trauma Data Bank of ACS. These data were used to estimate each center's Observed-to-Expected (O-E ratio) mortality ratio with 95% confidence intervals using multivariate logistic regression analysis. De-identified data on structural characteristics of these trauma centers were obtained from the ACS Verification Review Committee. Centers in the lowest quartile of mortality based on O-E ratio (n=56) were compared to the rest (n=166) using Classification and Regression Tree (CART) analysis to identify institutional characteristics independently associated with high performing centers. Results: Of the 72 structural characteristics explored, only three were independently associated with high performing centers: annual patient visits to the emergency department (ED) of 20%; and continuing medical education for ED physician liaison to the trauma program ranging between 55 and 113 hours annually. Each 5% increase in O-E mortality ratio was associated with an increase in total length of stay of one day (r=0.25, p

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