Variability in Management of Blunt Liver Trauma and Contribution of Level of ACS-COT Verification Status on Mortality

Background Patients who sustain blunt liver trauma and are treated at an ACS-COT verified level 1 trauma center have an overall lower risk of mortality compared with patients admitted to a level 2 trauma center. However, elements contributing to these differences are unknown. We hypothesize that practice variation exists between trauma centers in management of blunt liver injury. Our objective is to identify practice variations and their effect on clinical outcomes. Methods Data from a statewide collaborative quality initiative for trauma was utilized. The dataset contains information from 29 ACS-COT verified level 1 and 2 trauma centers from 2011 to 2016. Propensity score matching was used to create cohorts of patients treated at level 1 or 2 trauma centers. The 1:1 matched cohorts were used to compare in-hospital mortality, management strategy, complications, ICU and hospital LOS, and failure to rescue. Results 454 patients with grade 3 or higher blunt liver injury were included. Patients treated at level 2 trauma centers had higher in-hospital mortality than those treated at level 1 trauma centers (15.4% vs. 8.8%, p=0.03). Level 2 trauma centers utilized angiography less compared with level 1 centers (p=0.007) and admitted significantly fewer patients to the ICU (p=0.002). ICU status was associated with reduced mortality (7.2% vs. 23.9%, p

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