This article is more than 5 years old. Information may no longer be current.
Torso stab wound survival rate depends on level of trauma center
Patients with torso stab wounds have a significantly lower risk for mortality when treated at level I trauma centers compared to level II centers, according to findings recently published in JAMA Surgery.
“The American College of Surgeons verifies trauma centers, and the clinical care rendered at level I and level II centers is expected to be equivalent,” Miseker Abate, MD, PhD, a surgery resident at NewYork-Presbyterian and Weill Cornell Medical Center, and colleagues wrote.
However, studies have shown that patients with certain high mortality injuries had better outcomes in level I centers than in level II centers, according to the researchers.
Abate and colleagues reviewed data from patients aged 18 and older who were admitted to level I or level II trauma centers with torso stab wounds between January 2010 and January 2016. Those who had additional injuries to the head, neck and limbs were excluded from the study.
A total of 17,245 patients with torso stab wounds were included in the study, of whom 12,628 (73.2%) were treated at level I centers and 4,618 (26.8%) were treated at level II centers.
Patients treated at both centers had injuries with similar levels of severity.
Laparotomy was performed at a higher rate in level I centers (25.5% vs. 21.4%; P < .001) and in less time (median = 60 minutes vs. 67 minutes; P = .01) compared with level II centers.
Thoracotomy was performed in more patients in level I centers compared to level II centers (5.9% vs. 3.7%; P = .01). The time from admission to thoracotomy was similar in both types of centers.
According to the researchers, mortality was lower among those treated in level I vs. level II centers among those who received thoracotomy (24.3% vs. 34.1%; P = .01) and selective nonoperative management (3.1% vs. 3.7%; P =.04).
After adjusting for covariates, the researchers found that those treated at level I centers had lower risk for mortality compared with similar patients treated in level II centers.
The time from admission to surgery did not significantly affect mortality, they said.
“This study demonstrates that patients with torso stab wounds treated at level I centers have a lower risk of mortality when treated with thoracotomy or [selective nonoperative management], compared with patients at level II centers,” Abate and colleagues wrote.
They noted that it is possible level I trauma centers have better outcomes with thoracotomies because they perform more of the procedures and therefore have more experience than level II centers. However, additional research is needed to determine conclusively what led to the differences in mortality, they said.– by Erin Michael
Disclosures: The authors report no relevant financial disclosures.