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Trauma Management

OMS and Other Dental Specialists

Session: Oral Abstract Session Two

SA2 - Is Treatment at a Level I Trauma Center Associated With Improved Outcomes in Adults With Isolated Midface Trauma?

Friday, September 19, 2025
2:45 PM - 2:55 PM EDT
Location: Room 204C, Walter E. Washington Convention Center
Abstract:
Statement of the Problem: Treatment at a Level I trauma center has been associated with better outcomes for a diversity of injury burdens.1,2 However, it is unknown whether such a relationship exists in the context of isolated midface trauma. The purpose of this study was to: 1) compare the demographic of patients with isolated midface trauma at Level I and non-Level I trauma centers; and 2) investigate whether trauma center designation is independently associated with treatment outcomes following operative intervention including complications, hospital length of stay (LOS), return to the operating room, and adverse discharge disposition.
Materials and

Methods: This was a retrospective cohort study using the National Trauma Data Bank 2018-2022. Subjects with isolated midface trauma who underwent operative intervention based on International Classification of Diseases 10th edition diagnosis and procedural coding and Abbreviated Injury Scale codes were included in the analysis. The primary predictor variable was trauma center designation, categorized as Level I or non-Level I. The primary outcome variable was any complication. Secondary outcome variables included total hospital LOS, return to the operating room, and adverse discharge disposition. Covariates included demographic, medical, injury-related, and hospital variables. Multivariable regression analyses were used to evaluate the association between trauma center designation and adverse outcomes.

Results: There was a total of 66,195 subjects with isolated midface trauma, of which 37,439 (56.6%) presented to a Level I trauma center and 8,321 (12.6%) underwent operative intervention. Subjects who presented to a Level I trauma center were more likely to undergo an operative intervention compared to those at a non-Level I center (RR, 1.25; 95% CI, 1.20-1.30). Of the subjects who underwent operative intervention, 5,155 (62.0%) were treated at a Level Itrauma center and 91 (1.1%) experienced a complication. Multivariable regression models showed that trauma center designation was not associated with complications (OR, 0.96; 95% CI, 0.59-1.59), total hospital LOS (β, -0.04; 95% CI, -0.22-0.14), return to the operating room (OR, 1.27; 95% CI, 0.51-3.47), or adverse discharge disposition (OR, 1.11; 95% CI, 0.93-1.32). For the entire cohort, the most common complications were intensive care unit admission (0.6%) and unplanned intubation (0.4%). The overall mean hospital LOS was 4.3 ± 3.7 days.

Conclusions: Trauma center designation was not associated with overall complications, total hospital LOS, return to the operating room, or adverse discharge disposition. Further investigation is necessary to determine which patients, if any, will benefit most from treatment at a Level I trauma center for their facial injuries.

References:
1. Glance LG, Osler TM, Mukamel DB, Dick AW: Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers? J Am Coll Surg 215: 372, 2012.
2. Bell TM, Boustany KC, Jenkins PC, Zarzaur BL: The relationship between trauma center volume and in-hospital outcomes. J Surg Res 196: 350, 2015.