{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:12:33Z","timestamp":1755796353915,"version":"3.44.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sepsis is a major complication in trauma patients, leading to increased morbidity and mortality. Given the varying resource allocation across trauma center levels, the impact of trauma center designation on sepsis-related mortality remains unclear. This study examines the association between trauma center level and sepsis outcomes in trauma patients using data from the National Trauma Data Bank (NTDB) 2017 dataset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was conducted using the NTDB 2017 dataset at the American University of Beirut (AUB). Trauma patients who developed sepsis as a hospital complication were identified, and those meeting inclusion criteria were analyzed. Patient demographics, comorbidities, injury severity, hospital characteristics, and outcomes were compared across Level I, II, and III trauma centers. Multivariable logistic regression was performed to assess the association between trauma center designation and mortality after adjusting for confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,738 patients were included. The study population had a mean age of 56.34 \u00b1 19.54 years, with 72.9% being males and 69.2% of white race. Patients treated in a level I trauma center had a higher injury severity score (ISS \u2265 16) compared to those in other trauma center levels (62.9% vs. 54.5% vs. 22.6%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), and increased hospital complications, including ventilator-associated pneumonia (20% vs. 10.7% vs. 5.2%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001). ICU and OR admissions were significantly higher in Level I and II trauma centers than in Level III (47.9% and 45.9% vs. 30.4% and 30.9%, and 24.1% vs. 13%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001). Mortality rates were highest in Level I centers (62.4%) compared to Level II (30.8%) and Level III (6.8%), though this difference was not statistically significant after adjustment for confounders (<jats:italic>p<\/jats:italic> = 0.691). Multivariable analysis showed no significant association between trauma center designation and sepsis-related mortality when comparing Level II to Level I centers (OR = 0.785, 95% CI: 0.592\u20131.043; <jats:italic>p<\/jats:italic> = 0.095) and Level III to Level I centers (OR = 1.038, 95% CI: 0.454\u20132.372; <jats:italic>p<\/jats:italic> = 0.930).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sepsis-related mortality did not significantly differ across trauma level designation when adjusted for potential confounders. These findings highlight the importance of standardized sepsis management protocols across trauma centers as well as the importance of early sepsis recognition and intervention strategies in trauma patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1591624","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:28:38Z","timestamp":1755494918000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of trauma level designation on mortality in trauma patients with sepsis: an observational study across US trauma centers"],"prefix":"10.3389","volume":"12","author":[{"given":"Ralphe Bou","family":"Chebl","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Razan","family":"Diab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reem","family":"Siblini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rana","family":"Bachir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mazen","family":"El Sayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"journal-title":"Resources for Optimal Care of the Injured Patient.","year":"1993","key":"B1"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1001\/jama.1994.03510480043032","article-title":"Outcome of hospitalized injured patients after institution of a trauma system in an urban area.","volume":"271","author":"Mullins","year":"1994","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.1001\/jama.283.15.1990","article-title":"The effect of organized systems of trauma care on motor vehicle crash mortality.","volume":"283","author":"Nathens","year":"2000","journal-title":"JAMA."},{"key":"B4","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1056\/NEJMsa052049","article-title":"A national evaluation of the effect of trauma-center care on mortality.","volume":"354","author":"MacKenzie","year":"2006","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1097\/00005373-199508000-00008","article-title":"Trauma center designation: initial impact on trauma-related mortality.","volume":"39","author":"Sampalis","year":"1995","journal-title":"J Trauma Acute Care Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/s0002-9610(85)80039-8","article-title":"Impact of a trauma service on trauma care in a university hospital.","volume":"149","author":"Baker","year":"1985","journal-title":"Am J Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1001\/archsurg.1995.01430020106020","article-title":"The impact of a dedicated trauma program on outcome in severely injured patients.","volume":"130","author":"Demetriades","year":"1995","journal-title":"Arch Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1097\/01.sla.0000184169.73614.09","article-title":"The effect of trauma center designation and trauma volume on outcome in specific severe injuries.","volume":"242","author":"Demetriades","year":"2005","journal-title":"Ann Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.jamcollsurg.2012.03.018","article-title":"Impact of trauma center designation on outcomes: is there a difference between level I and level II trauma centers?","volume":"215","author":"Glance","year":"2012","journal-title":"J Am Coll Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.jss.2022.11.062","article-title":"An analysis of injured patients treated at level 1 trauma centers versus other centers: a scoping review.","volume":"284","author":"Matthews","year":"2023","journal-title":"J Surg Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1097\/TA.0000000000002850","article-title":"The association between level of trauma care and clinical outcome measures: a systematic review and meta-analysis.","volume":"89","author":"Van Ditshuizen","year":"2020","journal-title":"J Trauma Acute Care Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1097\/TA.0b013e3181929e2b","article-title":"Level I versus level II trauma centers: an outcomes-based assessment.","volume":"66","author":"Cudnik","year":"2009","journal-title":"J Trauma Acute Care Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1001\/archsurg.143.12.1213","article-title":"Effect of trauma center designation on outcome in patients with severe traumatic brain injury.","volume":"143","author":"DuBose","year":"2008","journal-title":"Arch Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1001\/archsurg.2007.2-b","article-title":"Reduced mortality at a community hospital trauma center: the impact of changing trauma level designation from II to I.","volume":"143","author":"Scarborough","year":"2008","journal-title":"Arch Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"36","DOI":"10.4103\/cmi.cmi_61_19","article-title":"Early management of trauma: the golden hour.","volume":"18","author":"Abhilash","year":"2020","journal-title":"Curr Med Issues."},{"key":"B16","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1016\/j.arcmed.2021.10.007","article-title":"Sepsis in trauma: a deadly complication.","volume":"52","author":"Mas-Celis","year":"2021","journal-title":"Arch Med Res."},{"key":"B17","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/00005373-199502000-00006","article-title":"Epidemiology of trauma deaths: a reassessment.","volume":"38","author":"Sauaia","year":"1995","journal-title":"J Trauma Acute Care Surg."},{"journal-title":"National Trauma Data Bank: About NTDB.","year":"2023","key":"B18"},{"journal-title":"American College of Surgeons Website. National Trauma Data Stan-dard: Data dictionary.","year":"2023","key":"B19"},{"journal-title":"American College of Surgeons Website. National Trauma Data Bank 2016: Annual Report.","year":"2023","key":"B20"},{"journal-title":"About the Verification, Review, and Consultation Program.","year":"1993","key":"B21"},{"key":"B22","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3).","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA."},{"key":"B23","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1017\/S1049023X21000510","article-title":"Association between mode of transportation and survival in adult trauma patients with blunt injuries: matched cohort study between police and ground ambulance transport.","volume":"36","author":"Sakr","year":"2021","journal-title":"Prehospital Disaster Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1017\/S1049023X22000346","article-title":"Association between mode of transportation and survival in adult trauma patients with penetrating injuries: matched cohort study between police and ground ambulance transport.","volume":"37","author":"Abou Arbid","year":"2022","journal-title":"Prehospital and Disaster Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1055\/a-0853-2054","article-title":"Sepsis 2019 - new trends and their implications for multiple trauma patients.","volume":"158","author":"Dickmann","year":"2020","journal-title":"Z Orthop Unfall."},{"key":"B26","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s13017-020-00343-y","article-title":"Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients.","volume":"15","author":"Koch","year":"2020","journal-title":"World J Emerg Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/j.jamcollsurg.2009.08.003","article-title":"Complication rates among trauma centers.","volume":"209","author":"Ang","year":"2009","journal-title":"J Am Coll Surgeons."},{"key":"B28","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1097\/TA.0000000000003890","article-title":"Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: a systematic review and meta-analysis.","volume":"94","author":"Van Ditshuizen","year":"2023","journal-title":"J Trauma Acute Care Surg."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1016\/j.ajem.2019.158390","article-title":"Impact of trauma level designation on survival of patients arriving with no signs of life to US trauma centers.","volume":"38","author":"Dakessian","year":"2020","journal-title":"Am J Emerg Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1097\/00005373-199810000-00034","article-title":"Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death.","volume":"45","author":"Perdue","year":"1998","journal-title":"J Trauma Acute Care Surg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2471","DOI":"10.1007\/s00068-024-02611-x","article-title":"Outcomes of severe isolated blunt chest trauma in young and geriatric patients.","volume":"50","author":"Panossian","year":"2024","journal-title":"Eur J Trauma Emerg Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1136\/emermed-2021-212184","article-title":"Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis.","volume":"40","author":"Battle","year":"2023","journal-title":"Emerg Med J."},{"key":"B33","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1111\/1475-6773.14148","article-title":"Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.","volume":"58","author":"Nguyen","year":"2023","journal-title":"Health Serv Res."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1097\/TA.0b013e3182183789","article-title":"In a mature trauma system, there is no difference in outcome (survival) between level I and level II trauma centers.","volume":"70","author":"Rogers","year":"2011","journal-title":"J Trauma Acute Care Surg."},{"key":"B35","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1097\/01.ta.0000053469.92142.40","article-title":"The relation between trauma center outcome and volume in the National trauma databank.","volume":"56","author":"Glance","year":"2004","journal-title":"J Trauma."},{"key":"B36","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.jss.2022.02.017","article-title":"Blunt trauma mortality: does trauma center level matter?","volume":"276","author":"Mehta","year":"2022","journal-title":"J Surg Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.jemermed.2020.06.018","article-title":"Association between trauma center level and outcomes of adult patients with motorcycle crash\u2013related injuries in the United States.","volume":"59","author":"Elsemesmani","year":"2020","journal-title":"J Emerg Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"e17721","DOI":"10.1097\/MD.0000000000017721","article-title":"Impact of trauma designation levels on survival of drowning victims: an observational study from trauma centers in the United States.","volume":"98","author":"Dakessian","year":"2019","journal-title":"Medicine."},{"key":"B39","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.ajem.2025.01.029","article-title":"Impact of trauma center designation level on survival in trauma during pregnancy: observational study across US trauma centers.","volume":"90","author":"Traboulsy","year":"2025","journal-title":"Am J Emerg Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1177\/000313481207800123","article-title":"The impact of american college of surgeons trauma center designation and outcomes after early thoracotomy: a national trauma databank analysis.","volume":"78","author":"Bukur","year":"2012","journal-title":"Am Surgeon."},{"key":"B41","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1177\/000313481107700313","article-title":"Outcomes after severe head injury: a national trauma data bank-based comparison of level I and level II trauma centers.","volume":"77","author":"Alkhoury","year":"2011","journal-title":"Am Surgeon."},{"key":"B42","doi-asserted-by":"publisher","first-page":"130","DOI":"10.4266\/acc.2018.00122","article-title":"Timing and associated factors for sepsis-3 in severe trauma patients: a 3-year single trauma center experience.","volume":"33","author":"Chung","year":"2018","journal-title":"Acute Crit Care."},{"journal-title":"Early Recognition and Initial Management of Sepsis in Adult Patients.","year":"2023","author":"King","key":"B43"},{"key":"B44","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.1056\/NEJMoa1701380","article-title":"Early, goal-directed therapy for septic shock \u2014 a patient-level meta-analysis.","volume":"376","author":"Investigators","year":"2017","journal-title":"N Engl J Med."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"B46","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction\/failure.","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1097\/00003246-199811000-00016","article-title":"Use of the SOFA score to assess the incidence of organ dysfunction\/failure in intensive care units: results of a multicenter, prospective study.","volume":"26","author":"Vincent","year":"1998","journal-title":"Crit Care Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"664966","DOI":"10.3389\/fmed.2021.664966","article-title":"Early prediction of mortality, severity, and length of stay in the intensive care unit of sepsis patients based on sepsis 3.0 by machine learning models.","volume":"8","author":"Su","year":"2021","journal-title":"Front Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1591624\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:28:39Z","timestamp":1755494919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1591624\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":48,"alternative-id":["10.3389\/fmed.2025.1591624"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1591624","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,8,18]]},"article-number":"1591624"}}