Hospital trauma level's association with outcomes for injured pregnant women and their neonates in Washington state, 1995-2012

Abstract

Background: Trauma occurs in 8% of all pregnancies. To date, no studies have evaluated the effect of the hospital's trauma designation level as it relates to birth outcomes for injured pregnant women.

Methods: This population-based, retrospective cohort study evaluated the association between trauma designation levels and injured pregnancy birth outcomes. We linked Washington State Birth and Fetal Death Certificate data and the Washington State Comprehensive Hospital Abstract Recording System. Injury was identified using the International Classification of Diseases, Ninth Revision injury diagnosis and external causation codes. The association was analyzed using logistic regression to estimate odds ratios and 95% confidence intervals (CIs).

Results: We identified 2492 injured pregnant women. Most birth outcomes studied, including placental abruption, induction of labor, premature rupture of membranes, cesarean delivery, maternal death, gestational age <37 weeks, fetal distress, fetal death, neonatal respiratory distress, and neonatal death, showed no association with trauma hospital level designation. Patients at trauma Level 1-2 hospitals had a 43% increased odds of preterm labor (95% CI: 1.15-1.79) and a 66% increased odds of meconium at delivery (95% CI: 1.05-2.61) compared to those treated at Level 3-4 hospitals. Patients with an injury severity score >9, treated at trauma Level 1-2 hospitals, had an aOR of low birth weight, <2500 g, of 2.52 (95% CI: 1.12-5.64).

Conclusions: The majority of birth outcomes for injured patients had no association with hospitalization at a Level 1-2 compared to a Level 3-4 trauma center.

Keywords: Hospital trauma level; injury; injury severity score; maternal; neonatal; pregnancy; trauma; trauma system.