|
Citation
|
Truong EI, Ho VP, Tseng ES, Ngana C, Curtis J, Curfman ET, Claridge JA. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub. |
|
Abstract
|
OBJECTIVES: Trauma centers (TCs) are inconsistently distributed throughout the US. It is unclear if new TCs improve care and decrease mortality. We tested the hypothesis that increases in TCs are associated with decreases in injury-related mortality (IRM) at the state level.
METHODS: We used data from the American Trauma Society to geolocate every state-designated or ACS-verified TC in all 50 states and DC from 2014-2018. These data were merged with publicly available IRM data from the Centers for Disease Control and Prevention. We used geographic information systems methods to map and study the relationships between TC locations and state-level IRM over time. Regression analysis, accounting for state-level fixed effects, was used to calculate the effect of total statewide number of TC on IRM and year-to-year changes in statewide TC with the IRM (shown as deaths per additional TC per 100,000 population, p-value).
RESULTS: Nationwide between 2014 and 2018, the number of TC increased from 2039 to 2153. IRM also increased over time. There was notable interstate variation, from 1 to 284 TCs. Four patterns in statewide TC changes emerged: static (12), increased (29), decreased (5), or variable (4). Of states with TC increases, 26 (90%) had increased IRM between 2014 and 2017, while the remaining 3 saw a decline. Regression analysis demonstrated that having more trauma centers in a state was associated with a significantly higher IRM rate (0.38, p=0.03); adding new trauma centers was not associated with changes in IRM (0.02, p=0.8).
CONCLUSION: Having more TC and increasing the number of TC within a state is not associated with decreases in state-level IRM. In this case, more is not better. However, more work is needed identify the optimal number and location of trauma centers to improve IRM. LEVEL OF EVIDENCE: III, Epidemiologic.
Language: en |