Association Between Trauma Center Level and Outcomes of Adult Patients with Motorcycle Crash–Related Injuries in the United States

Abstract

Background: Motorcycle crash–related injury mechanism is a criterion in the Centers for Disease Control and Prevention field triage guidelines of injured patients, with a recommendation to transport affected patients to a trauma center need not be the highest level. Objective: This study examines the evidence behind this recommendation because severe injuries can result from motorcycle crashes and patients can benefit from treatment at higher-level trauma centers. Methods: This retrospective cohort study used the National Trauma Data Bank 2015 dataset. We conducted descriptive analyses (univariate and bivariate) followed by adjusted multivariate analysis to examine the association between trauma center designation levels and survival to hospital discharge. Results: A total of 28,821 patients with motorcycle injuries were included. Most patients were men (n = 25,361; 88%) and aged between 16 and 64 years (n = 26,989; 93.6%). Survival rates were higher in level II (n = 10,658; 95.3%) and III (n = 2,129; 95.5%) trauma centers compared to level I centers (n = 14,498; 94.6%). After adjusting for confounders, decreased survival to hospital discharge was noted for patients treated at level III trauma centers compared to those at level I centers (odds ratio 0.543; 95% confidence interval 0.390–0.729). No difference in survival was noted between level I and II centers. Conclusions: Patients with motorcycle crash–related injuries treated at higher-level trauma center (I or II) had increased survival. This warrants a re-evaluation and adjustment of the field triage criterion for such patients. Examining the evidence behind field triage guidelines in trauma systems is needed for improved patient outcomes. © 2020 Elsevier Inc.