Are all level I XXXX centers created equal? A comparison of American College of Surgeons and state-verified centers.

@entity1 @entity649 @entity130
Scant literature investigates potential outcome differences between Level I @entity130 centers. We compared overall survival and survival after @entity649 ( @entity649 ) in @entity1 admitted to American College of Surgeons (ACS)-verified versus state-verified Level I @entity130 centers. Using the National @entity130 Data Bank Version 7.0, incident codes associated with admission to an ACS-verified facility were extracted and compared with the group admitted to state-verified centers. Overall, there were 382,801 (73.7%) @entity1 admitted to ACS and 136,601 (26.3%) admitted to state centers. There was no adjusted survival advantage after admission to either type (4.9% for ACS vs 4.8% for state centers; 1.014 [95% CI, 0.987 to 1.042], P = 0.311). However, in the 3,088 cases of @entity649 , mortality for admission to the ACS centers was 20.3 per cent (451 of 2,220) versus 27.1 per cent (235 of 868) for state centers. Adjusting for injury severity and facility size, admission to an ACS center was associated with a significantly greater survival after @entity649 (0.75 [0.654 to 0.860]; P < 0.001). Level I verification does not necessarily imply similar outcomes in all subgroups. Federal oversight may become necessary to ensure uniformity of care, maximizing outcomes across all United States @entity130 systems. Further study is needed.
