Trends in Volumes of Spine Fractures Across Different Trauma Center Levels: A National Trauma Databank Study

Introduction: Trauma centers are essential for managing spinal fractures, but it is unknown how the proliferation of non-Level 1 trauma centers has affected the distribution of fracture care. This study evaluates trends in spinal fracture volumes across trauma center levels over time.

Methods: Data from the National Trauma Databank (NTDB) between 2017 and 2022 were used to track cervical, thoracic, and lumbar fractures (with and without spinal cord injury [SCI]) across trauma centers. Logistic regression assessed the impact of trauma center level, age, sex, and Injury Severity Score (ISS) on discharge outcomes. Boxplots and scatterplots were used to visualize the relationship between ISS, trauma center level, and outcomes.

Results: Between 2017 and 2022, the number of Level 1 trauma centers decreased from 239 to 220, while non-Level 1 centers increased from 492 to 791. Despite fewer Level 1 centers, the average volume of spinal fractures managed by Level 1 centers rose from 360 fractures per center in 2017 to 520 fractures per center in 2022. In contrast, non-Level 1 centers experienced a slight decrease, from 85 fractures per center in 2017 to 75 in 2022. A boxplot showed that Level 1 centers treat more severe injuries than non-Level 1 centers. However, a scatterplot of predicted outcomes indicated that trauma center level does not significantly affect the probability of a good outcome once adjusting for injury severity score.

Conclusion : Despite fewer Level 1 centers, the volume of complex spinal fracture cases they manage has increased. Non-Level 1 centers have expanded, potentially reducing the burden on Level 1 centers. After adjusting for injury severity, trauma center level does not significantly impact the probability of a good outcome, emphasizing the importance of injury severity in determining discharge outcomes.