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Level I versus Level II

p.bjorn at netzero.net p.bjorn at netzero.net
Mon Oct 17 20:41:10 BST 2005

I admit that I have been trying to ignore this thread: my hospital is undergoing an ACS Level II verification visit in December, and I didn't want to jinx or unduly depress myself.  Further, I'm not a frequent reader of the Annals of Surgery, and haven't gotten around to reading more than the abstract of Dr. Demetriades' study: we haven't received the October Annals yet.

All that said, it's odd that the Annals article seems to have little grasp on important distinctions.  Specifically, it refers continuously to the ACS as a "designating" body -- a role the College has strenuously avoided.  Designation is a functional stratification determined within states and systems; the ACS merely verifies that centers meet specific care, quality, and capacity criteria.  In some systems, ACS verification is used for trauma center designation; but hardly all.

One wonders, then, if the NTDB data was properly filtered for this study.  

Perhaps other list members have more familiarity: does the NTDB distinguish between verification and designation?  If not, the data may be contaminated by two-level trauma systems, wherein Level I centers are the main tertiary care hospitals, and Level II's comprise all others.  Clearly, this would affect outcome comparisons.

Hard to believe that the Annals would publish this without having the methodology and terminology more clear.

Sorry for being late to the party.  Hope my questions and comments aren't redundant...

Pret Bjorn, RN, etc.
Eastern Maine Medical Center
Bangor, ME USA

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