Original Contribution  |   May 2020
Does the Halo Effect for Level 1 Trauma Centers Apply to High-Acuity Nonsurgical Admissions?
Author Notes
  • From One:MAP Surgical Analytics (Drs Hwalek, Kothari, Wood, Kuo, and Posluszny) at the Department of Surgery at Loyola University Medical Center in Maywood, Illinois (Drs Hwalek, Kothari, Wood, Blanco, Plackett, Kuo, and Posluszny and Ms Brown). 
  • Financial Disclosures: None reported. 
  • Support: This work was funded, in part, by NIH training grant T32GM008750 (AEH, ANK). 
  •  *Address correspondence to Timothy P. Plackett, DO, MPH, 13 DuPont Pl, Fort Bragg, NC 28307-2012. Email: tplacke78@gmail.com
     
Article Information
Emergency Medicine
Original Contribution   |   May 2020
Does the Halo Effect for Level 1 Trauma Centers Apply to High-Acuity Nonsurgical Admissions?
The Journal of the American Osteopathic Association, May 2020, Vol. 120, 303-309. doi:https://doi.org/10.7556/jaoa.2020.049
The Journal of the American Osteopathic Association, May 2020, Vol. 120, 303-309. doi:https://doi.org/10.7556/jaoa.2020.049
Abstract

Context: The halo effect describes the improved surgical outcomes at trauma centers for nontrauma conditions.

Objective: To determine whether level 1 trauma centers have improved inpatient mortality for common but high-acuity nonsurgical diagnoses (eg, acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia [PNA]) compared with non­–level 1 trauma centers.

Methods: The authors conducted a population-based, retrospective cohort study analyzing data from the Healthcare Cost and Utilization Project State Inpatient Database and the American Hospital Association Annual Survey Database. Patients who were admitted with AMI, CHF, and PNA between 2006-2011 in Florida and California were included. Level 1 trauma centers were matched to non–level 1 trauma centers using propensity scoring. The primary outcome was risk-adjusted inpatient mortality for each diagnosis (AMI, CHF, or PNA).

Results: Of the 190,474 patients who were hospitalized for AMI, CHF, or PNA, 94,037 patients (49%) underwent treatment at level 1 trauma centers. The inpatient mortality rates at level 1 trauma centers vs non–level 1 trauma centers for patients with AMI was 8.10% vs 8.40%, respectively (P=.73); for patients with CHF, 2.26% vs 2.71% (P=.90); and for patients with PNA, 2.30% vs 2.70% (P=.25).

Conclusion: Level 1 trauma center designation was not associated with improved mortality for high-acuity, nonsurgical medical conditions in this study.

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