Chest Trauma Outcomes: Public Versus Private Level I Trauma Centers

Abstract

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.

Fig. 1

a The bar graph shows the number of hospital-beds, UCI-beds and operating rooms registered by 2019 in the Ministerio de Salud y Proteccion Social (National Ministry of Health) in the Private Trauma Center (Private TC) and Public Trauma Center (Public TC). b This bar graph shows the volume of trauma patients admitted during 2018 at the emergency service from both hospitals. Even though there were a higher volume of admissions in the Private TC, of these, just 1319/13,242 = 10% were admitted as an inpatient. On the other hand, a higher proportion were admitted as an inpatient in the Public TC (3021/4944 = 61%)

Fig. 2

Area under curve for the Logistic regression model