Dr. Morshed and colleagues studied a topic that many orthopaedic trauma surgeons must dutifully address: the level of care for patients with the critical injuries of traumatic pelvic ring and acetabular fractures. The study was diverse; the authors examined mortality and quality-of-life-related scores among patients treated in eighteen hospitals with level-I trauma centers and fifty-one hospitals without trauma centers (nontrauma centers) in fourteen U.S. states. In total, they examined 829 adult patients (eighteen to eighty-four years of age) who had sustained a pelvic ring or acetabular injury. Through extensive statistical analysis, they concluded that trauma centers had much more favorable rates than nontrauma centers in terms of reduced mortality and improved physical function at one year of follow-up among patients with more severe injuries.

This study goes to the heart of what was established by Dalal et al. in 1989, in that the critically injured trauma patient benefits most when treated by an organized trauma service with integrated multidisciplinary care. Comparisons between trauma centers and nontrauma centers continue to generate scholarly study. In early 2014, Vallier et al. identified the barriers to timely definitive fixation, comparing those who were transferred to the authors’ level-I center with those who arrived directly. The heart of that study’s results is that transferred patients were more likely to have delayed fixation.

These findings are not a direct degradation of all nontrauma centers. Trauma centers are required to achieve and maintain the highest level of standards for the treatment and organization of critically injured patients. The American College of Surgeons classification criteria are a good guide for this.