The association between direct admission to level I trauma centers and lower in-hospital mortality in operative spine trauma.

Authors

• Mitchell K Ng
• Leonidas E Mastrokostas
• Paul G Mastrokostas
• Sean Inzerillo
• Jad Bou Monsef
• Afshin E Razi
• Nicholas U Ahn
• Zachary Wilt
• Mark F Kurd
• Ian David Kaye
• Barrett Woods
• Daniel R Fassett
• Andrew P Alvarez
• Jose A Canseco
• Thomas D Cha
• Alan S Hilibrand
• Alexander R Vaccaro
• Gregory D Schroeder
• Christopher K Kepler

Publication/Presentation Date

8-28-2026

Abstract

OBJECTIVE: The aim of this study was to evaluate whether trauma center level is associated with in-hospital mortality among patients undergoing operative management for spine trauma and to determine whether this relationship differs according to triage pathway.

METHODS: A retrospective cohort study was performed using the 2023 National Trauma Data Bank. Adult patients undergoing operative treatment for spine trauma at American College of Surgeons-verified level I or level II trauma centers were identified. Patients with polytrauma or incomplete clinical data were excluded. Demographics, injury characteristics, comorbidities, arrival physiology, and hospital factors were compared between trauma center levels. Multivariable logistic regression models were constructed to assess the association between trauma center level and in-hospital mortality, stratified by triage pathway (direct admission vs interfacility transfer) and adjusted for demographic, injury severity, physiological, and hospital covariates. Significance was set at the p < 0.05 level.

RESULTS: A total of 12,516 operative spine trauma encounters were included, with 8548 treated at level I centers and 3968 at level II centers. Level I centers managed patients with greater injury severity and higher comorbidity burden and received a larger proportion of interfacility transfers. Among directly admitted patients, treatment at a level I trauma center was associated with significantly lower adjusted odds of in-hospital mortality compared with level II centers (adjusted OR 0.62, 95% CI 0.39-0.97; p = 0.037). No significant mortality difference was observed among transferred patients (adjusted OR 0.88, 95% CI 0.47-1.68; p = 0.693).

CONCLUSIONS: Level I trauma center care was associated with reduced adjusted mortality among directly admitted operative spine trauma patients but not among transferred patients. These findings suggest that early access to specialized multidisciplinary spine trauma care, rather than trauma center designation alone, may drive improved survival and highlight the importance of optimized prehospital triage and direct transport strategies.

First Page

1

Last Page

7

ISSN

1547-5646

Published In/Presented At

Ng, M. K., Mastrokostas, L. E., Mastrokostas, P. G., Inzerillo, S., Bou Monsef, J., Razi, A. E., Ahn, N. U., Wilt, Z., Kurd, M. F., Kaye, I. D., Woods, B., Fassett, D. R., Alvarez, A. P., Canseco, J. A., Cha, T. D., Hilibrand, A. S., Vaccaro, A. R., Schroeder, G. D., & Kepler, C. K. (2026). The association between direct admission to level I trauma centers and lower in-hospital mortality in operative spine trauma. Journal of neurosurgery. Spine, 1–7. Advance online publication. https://doi.org/10.3171/2026.4.SPINE26178

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

42664523

Department(s)

Administration and Leadership

Document Type

Article