Motor vehicle crashes in New York state: Importance of accounting for emergency department deaths when assessing differences in in-hospital mortalityby level of care

Background: Motor vehicle crashes (MVCs) are one of the leading causes of d eath in the nation and in New York State, particularly among younger adult males. It is important to study how to reduce mortality from MVCs, Methods: Hospitalized victims of mo tor vehicle crashes in the 1994-1995 Ne w York State Trauma Registry were identified for the study. A statistical m odel was used to calculate risk-adjusted mortality rates for groups of hosp itals constituting each level of care (regional trauma center, area trauma center, noncenter), Levels of care were also compared with respect to the l ocation of deaths in the hospital (emergency department, inpatient), and th e time between emergency department admission and death for patients dying in the hospital, Results: The risk-adjusted mortality rate for MVCs in patients in regional centers was higher, although not significantly higher (6.91%; 95% confidenc e interval [CI], 6.18%-7.70%) than for area centers (5.53%; 95% CI, 4.43%-6 .82%) or for noncenters (5.83%; 95% CI, 4.70%-7.15%), However, regional cen ters admitted seriously injured trauma patients from the emergency departme nt much more quickly than other levels of care. Whereas only 18% of all in- hospital deaths occurred in emergency departments of regional centers, the comparable percentages for area centers and noncenters were 39% and 46%, re spectively. Also, 43% of all deaths in regional centers occurred within 24 hours of presentation to the emergency department, compared with 15% in are a centers and 21% in noncenters, Conclusion: Risk-adjusted inpatient mortality rates for victims of MVCs may not yield a fair comparison of performance for different levels of care or for different hospitals because of differences in how quickly emergency de partment patients are admitted to the hospital, A more equitable way to ass ess hospital mortality rates may be to include emergency department deaths in addition to inpatient deaths.