Citation

MacKenzie EJ, Hoyt DB, Sacra JC, Jurkovich GJ, Carlini AR, Teitelbaum SD, Teter H. J. Am. Med. Assoc. JAMA 2003; 289(12): 1515-1522.

Affiliation

Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Md 21205, USA. emackenz@jhsph.edu

Copyright

(Copyright © 2003, American Medical Association)

DOI

10.1001/jama.289.12.1515

PMID

12672774

Abstract

CONTEXT: Trauma centers benefit thousands of injured individuals every day and play a critical role in responding to disasters. The last full accounting of the number and distribution of trauma centers identified 471 trauma centers in the United States in 1991. OBJECTIVE: To determine the number and configuration of trauma centers and identify gaps in coverage. DESIGN, SETTING, AND SUBJECTS: Interviews with trauma center directors (September 2001 to April 2002), data from the American Hospital Association's Annual Survey of Hospitals (2000), and the US Health Resources Administration's Area Resource File (2001) were used to determine characteristics of trauma center hospitals and the geographic areas they serve in all 50 states and in the District of Columbia. Characteristics of trauma centers were examined by level of care and compared with nontrauma centers. Hospitals are designated or certified as trauma centers by a state or regional authority or verified as trauma centers by the American College of Surgeons Committee on Trauma. Trauma centers that treat only children (n = 31) were excluded. MAIN OUTCOME MEASURE: Total number of trauma centers and number of trauma centers per million population. RESULTS: In 2002, there were 1154 trauma centers in the United States, including 190 level I centers and 263 level II centers. Several states have categorized every hospital with an emergency department at some level of trauma care while others have designated a limited number of level I and level II centers only. The number of level I and II centers per million population ranges from 0.19 to 7.8 by state. When compared with nontrauma center hospitals, trauma centers are larger, more likely to be teaching hospitals, and more likely to offer specialized services. CONCLUSIONS: Although the availability of trauma centers has improved, challenges remain to ensure the optimal number, distribution, and configuration of trauma centers. These challenges must be addressed, especially in light of the recent emphasis on hospital preparedness and homeland security.