Open AccessChest Trauma Outcomes: Public Versus Private Level I Trauma Centers
Author(s) -
Orlas Claudia P.,
HerreraEscobar Juan Pablo,
Zogg Cheryl K.,
Serna José J.,
Meléndez Juan J.,
Gómez Alexandra,
Martínez Diana,
Parra Michael W.,
García Alberto F.,
Rosso Fernando,
Pino Luis Fernando,
Gonzalez Adolfo,
Ordoñez Carlos A.
Publication year - 2020
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-020-05400-w
Subject(s) - medicine , trauma center , logistic regression , injury severity score , mediastinitis , odds ratio , cardiothoracic surgery , pneumonia , cardiac surgery , surgery , retrospective cohort study , emergency medicine , poison control , injury prevention
Background The goal of our study was to evaluate the differences in care and clinical outcomes of patients with chest trauma between two hospitals, including one public trauma center (Pu‐TC) and one private trauma center (Pri‐TC). Methods Patients with thoracic trauma admitted from January 2012 to December 2018 at two level I trauma centers (Pu‐TC: Hospital Universitario del Valle, Pri‐TC: Fundación Valle del Lili) in Cali, Colombia, were included. Multivariable logistic regression was used to assess for differences in in‐hospital mortality, adjusting for relevant demographic and clinical characteristics. Results A total of 482 patients were identified; 300 (62.2%) at the Pri‐TC and 182 (37.8%) at the Pu‐TC. Median age was 27 years (IQR 21–36) and median Injury Severity Score was 25 (IQR 16–26). 456 patients (94.6%) were male, and the majority had penetrating trauma [total 465 (96.5%); Pri‐TC 287 (95.7%), Pu‐TC 179 (98.4%), p 0.08]. All patients arrived at the emergency room with unstable hemodynamics. There were no statistically significant differences in post‐operative complications, including retained hemothorax [Pri‐TC 19 vs. Pu‐TC 18], pneumonia [Pri‐TC 14 vs. Pu‐TC 14], empyema [Pri‐TC 13 vs. Pu‐TC 13] and mediastinitis [Pri‐TC 6 vs. Pu‐TC 2]. Logistic regression did, however, show a higher odds of mortality when patients were treated at the Pu‐TC [OR 2.27 (95% CI 1.34–3.87, p < 0.001]. Conclusions Our study found significant statistical differences in clinical outcomes between patients treated at a Pu‐TC and Pri‐TC. The results are intended to stimulate discussions to better understand reasons for outcome variability and ways to reduce it.