Ten South Carolina hospitals made a list released this week of the top 405 medical centers nationally recognized for following recommended standards when treating patients with heart attacks, asthma and other conditions.

Trident Health System -- Trident, Summerville and Moncks Corner medical centers -- made the cut. But many larger hospitals, including the Medical University of South Carolina, are notably missing.

The president of the Joint Commission, which is the leading hospital accreditation board in the country and the group that released the report, said facilities on the list show an "exemplary level of performance."

"These hospitals are leading the way, as American hospitals as a whole continue to improve quality performance," Mark Chassin wrote in the Joint Commission's report, which uses data from 2010.

Some health care experts, however, cautioned patients to use the list and others like it skeptically.

"These hospitals should be proud of what they have accomplished, but consumers should be careful when looking at it," said Rick Foster, vice president of quality and patient safety at the S.C. Hospital Association. Other publicly available hospital comparisons, including data on the Hospital Association's own website, use different and sometimes stricter measures, he said.

For its list, the Joint Commission considered 22 measures, including giving aspirin to heart attack patients as soon as they arrive, providing antibiotics to patients an hour before surgery and giving flu vaccinations to pneumonia patients.

Patrick Cawley, medical director at MUSC, said hitting some of those targets can be difficult for larger teaching hospitals, which take complex patients referred by smaller ones.

About 14 percent of eligible hospitals nationally made the list, the first of its kind compiled by the Joint Commission. Many of the top hospitals listed are small and located in rural areas.

Lower patient volume might have skewed the results in favor of some smaller hospitals, Foster said.

"When you're larger, there's less variability and it's harder to significantly bump up your performance," he said.

Foster said about a dozen of the state's 67 acute-care medical centers do not use the Joint Commission for accreditation, meaning they would not appear on the list regardless of their results. None of them are in the Charleston area, he said.