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Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non–trauma centers).

Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non–trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non–trauma centers.

After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at …