ACS-COT Verification Level Affects Trauma Center Management of Pelvic Ring Injuries and Patient Mortality

Background Pelvic ring fractures represent a complex injury that requires specific resources and clinical expertise for optimal trauma patient management. We examined the impact of treatment variability for this type of injury at Level 1 and 2 trauma centers on patient outcomes. Methods Trauma quality collaborative data (2011-2017) were analyzed. This includes data from 29 ACS-COT verified Level 1 and Level 2 trauma centers. Inclusion criteria were adult patients (≥ 16 years), ISS ≥ 5, blunt injury, and evidence of a partially stable or unstable pelvic ring fracture injury coding as classified using Abbreviated Injury Scale version 2005, with 2008 updates. Patients directly admitted, transferred out for definitive care, with penetrating trauma, or with no signs of life were excluded. Propensity score matching was used to create 1:1 matched cohorts of patients treated at Level 1 or 2 trauma centers. Trauma center verification level was the exposure variable used to compare management strategies, resource utilization, and in-hospital mortality in univariate analysis. Results We selected 1,220 well matched patients, from 1,768 total patients, using propensity score methods (610 Level 1 and 610 Level 2 cohort). There were no significant baseline characteristic differences noted between the groups. Patients with pelvic ring fractures treated at Level 1 trauma centers had significantly decreased mortality (7.7 vs. 11.6%, p=0.02). Patients treated at Level 2 trauma centers were less likely to receive interventional angiography, undergo complicated definitive orthopedic operative treatment, and to be admitted to an ICU. Conclusions Admission with a partially-stable or unstable pelvic ring injury to a Level 1 trauma center is associated with decreased mortality. Level 2 trauma centers had significantly less utilization of advanced treatment modalities. This variation in clinical practice highlights potential processes to emphasize in the appropriate treatment of these critically ill patients. Level of Evidence Level II, Economic/Decision This study will be presented at the 77th annual meeting of American Association for the Surgery of Trauma Meeting, September 26-29, 2018, in San Diego, CA. Manuscript Correspondence: Bryant W. Oliphant, MD, MBA, MSc, Research Investigator, Department of Orthopaedic Surgery, University of Michigan, North Campus Research Complex – 014-G016-11, 2800 Plymouth Rd. Ann Arbor, MI 48109-2800, Office: (734) 936-9839, Cell: (248) 761-6530, Fax: (734) 647-3277, Email: bryantol@med.umich.edu Reprints will not be available from the authors. Funding/Support: This study was supported by a Blue Cross Blue Shield of Michigan and Blue Care Network Collaborative Quality Initiatives grant to Michigan Medicine and Mark R. Hemmila for administration of the Michigan Trauma Quality Improvement Program. Conflicts of Interest Disclosure: Mark R. Hemmila receives salary support from Blue Cross Blue Shield of Michigan and Blue Care Network (a nonprofit mutual company) through their funding of the Michigan Trauma Quality Improvement Program. The company had no role in the study. There are no other conflicts to disclose. © 2018 Lippincott Williams & Wilkins, Inc.

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