• Alik Dakessian, Rana Bachir, and Mazen El Sayed.
• Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ad86@aub.edu.lb.
• Am J Emerg Med. 2020 Jun 1; 38 (6): 1129-1133.

BackgroundTrauma level designation and verification are examples of healthcare regionalization aiming at improving patient outcomes. This study examines impact of Trauma Levels on survival of patients arriving with "no signs of life" to US trauma centers.MethodsThis retrospective study used the US National Trauma Data Bank (NTDB) 2015 dataset. A descriptive followed by a bivariate analysis was done comparing variables by the trauma designation levels. A multivariate analysis assessed the effect of the trauma designation on survival to hospital discharge after controlling for potential confounding factors.Results6160 patients without signs of life were included. The average age was 40.66 years (±19.96) with male predominance (77.3%). Most patients were transported using ground ambulance (83.5%) and were taken to Level I (57%) and Level II (32.4%) centers. Blunt injuries were the most common (56.9%). Motor Vehicle Collision (MVC) (38.5%) and firearm (33.8%) were the most common mechanisms of injury. Survival to hospital discharge among patients with no signs of life ranged from 13.7% at Level I to 27.9% at Level III. After adjusting for confounders, including Injury Severity Score (ISS), higher survival was noted at Level II trauma centers compared to Level I.ConclusionsPatients presenting without signs of life to Level II trauma centers had higher survival to hospital discharge compared to Level I and Level III centers. These findings can guide future prehospital triage criteria of trauma patients in organized Emergency Medical Services (EMS) systems and highlight the need for more outcome research on trauma systems.Copyright © 2019 Elsevier Inc. All rights reserved.

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