Trauma center designation and the decreasing incidence of post-traumatic acute respiratory distress syndrome: A potential guidepost for quality improvement

Abstract

Background The incidence of post-traumatic acute respiratory distress syndrome (ARDS) is decreasing. We hypothesized that disparities exist in the overall incidence and incidence of ARDS over time across different types of trauma centers. Methods The National Trauma Databank version 7.0 was queried for patients admitted to designated trauma centers (I–III) and ventilated at least 48 hours. Level I university admissions (group 1) were compared with level I community and level II/III center admissions (group 2). Results There were 43,664 patients with an incidence of ARDS of 5.2% (2,260) overall, 4.1% (1,062/25,937) in group 1, and 6.8% (1,198/17,727) in group 2 ( P < .001). The incidence decreased significantly in group 1 in contrast to group 2 yearly. The incidence in level I community centers was marked (608/5,180 [11.7%]) and increased significantly over time. On logistic regression, admission to a level I university center (.646 [.590–.707],<.001) was independently associated with ARDS. Conclusions Admission to a level I center may not necessarily confer similar results reflecting potential variation in management between centers that presumably provide similar service. These investigations may have significance to quality improvement.