The following is the summary of “Trauma center designation level and survival of patients with chest wall instability” published in the December 2022 issue of Emergency medicine by Traboulsy, et al.


If you suspect you have chest wall instability, you should seek medical attention at a trauma center immediately. Even though patients with chest wall instability are often diverted to higher- or lower-level trauma centers, the effect of this on outcomes has not been studied. Those with chest wall instability treated at a Level I, Level II, or Level III trauma center were compared for their chances of survival to hospital discharge. Using information from the 2017 National Trauma Data Bank (NTDB) dataset, this study is a retrospective cohort observational in nature. Patients over 18 who went to the emergency room complaining of chest wall instability or deformity made up the study sample. 

A descriptive analysis was performed. Comparisons were made between hospitals, patients’ demographic and clinical features, and outcomes using “trauma designation level” as the primary independent variable. Following adjustment for most of the NTDB-extracted covariates, LASSO regression was used to assess the effect of trauma classification level on patient survival. About 1,172 patients with chest wall instability or deformity were included in the study. The median age of our patients was 52, and the vast majority were men (78.2%). The majority were sent to either a level I (51.5%) or level II (43.2%) trauma facility. The percentage of patients who made it to the point of being able to leave the hospital after treatment was 78. 

After controlling for potential confounding factors, there was no difference in survival between patients taken to level II [odds ratio (OR)=1.000; 95% CI=0.976-1.025] or III [odds ratio (OR)=1.000; 95% CI=0.993-1.007] trauma centers and those taken to level I facilities. When patients with chest wall instability were transferred to level II or level III hospitals, they fared just as well as those transferred to level I hospitals. This study underscores the need for greater outcome research in organized trauma systems and can inform pre-hospital field triage standards for this specific type of injury.

Source: sciencedirect.com/science/article/abs/pii/S0735675722006064