SUMMARY:

• Trauma is a life-threatening complication of sepsis.

• Mortality is tied to trauma center level designation.

• Trauma sepsis patients have higher mortality rates than non-sepsis trauma patients.

REVIEW:

• Trauma centers are designated into different levels based on resources, volumes, and commitment to education and research.

• Trauma center levels correlate to injury severity scores and with mortality.

• 60% of trauma deaths occur in the initial hours of hospital admission.

• Sepsis is the  most life threatening complication secondary to trauma.

• Approximately 10% of trauma patients develop sepsis, usually within the first few days of admission.

• Trauma patients who develop sepsis have higher mortality rates than those who do not develop sepsis.

• Chung et al. Acute and Critical Care 2018;33(3):130-134

• • 422 trauma patients

• • 50 (11.9%) developed sepsis

• • Sepsis patients were characterized with:

• • • Lower GCS scores

• • • Longer ICU length of stay

• • • Higher mortality

• The incidence of sepsis in trauma patients based on level of trauma center has recently been addressed.

• • Chebl et al. 2025;Front Med 12:1591624. Doi:10.3389/fmed.2025.1591624

• • Retrospective cohort of National Trauma Data Bank

• • 900 trauma centers from 2017

• • Trauma Level Definitions:

• • • I: University based, advanced trauma research

• • • II: Care for most trauma injuries, potential education & research

• • • III: Rural community, mild to moderate injuries, transfer of more serious injuries

• • Sepsis-3 definition

• • After adjustment for clinically significant variables (patient demographics, injury, severity score, complications, hospital type), there was no difference in sepsis mortality between the different trauma levels of care.

• The difference between death and survival was not statistically significantly different based on trauma center level.

• Limitations of these findings include:

• • Small Level III sample size

• • Unknown sepsis information including: timing of sepsis; fluid resuscitation, antibiotic administration, use of order sets.

• Trauma management focuses on the immediate resuscitation and stabilization.

• If trauma patients survive their initial injury, sepsis identification and management should be a concern across all trauma center levels.

SUMMARY:

• Sepsis occurs in approximately 10% of trauma patients and is a major cause of life-threatening illness.

• Trauma patients with sepsis have a poorer outcome than trauma patients without sepsis.

• Sepsis mortality does not appear to be influenced by the trauma center level designation.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.