Current Patterns of Trauma Center Proliferation Have Not Led to Proportionate Improvements in Access to Care or Mortality After Injury: An Ecologic Study.

Overview

abstract

BACKGROUND: Timely access to high level (I/II) trauma centers (HLTC) is essential to minimize mortality after injury. Over the last 15-years there has been a proliferation of HLTC nationally. The current study evaluates the impact of additional HLTC on population access and injury mortality. METHODS: A geocoded list of HLTC, with year designated, was obtained from the American Trauma Society, and 60-minute travel time polygons were created using OpenStreetMap data. Census block group population centroids, county population centroids, and American Communities Survey data from 2005 and 2020 were integrated. Age-adjusted non-overdose injury mortality was obtained from CDC, Wide-ranging Online Data for Epidemiologic Research (WONDER), and the Robert Wood Johnson Foundation (RWJF). Geographically weighted regression models were used to identify independent predictors of HLTC access and injury mortality. RESULTS: Over the 15-year (2005-2020) study period, the number of HLTC increased by 31.0% (445 to 583), while population access to HLTC increased by 6.9% (77.5% to 84.4%). Despite this increase, access was unchanged in 83.1% of counties, with a median change in access of 0.0% (IQR 0.0 - 1.1%). Population-level age-adjusted injury mortality rates increased by 5.39/100,000 population during this time (60.72 to 66.11/100,000).Geographically weighted regression controlling for population demography and health indicators found higher median income and higher population density to be positively associated with majority (≥50%) HLTC population coverage, and negatively associated with county-level non-overdose mortality. CONCLUSIONS: Over the past 15 years, the number of HLTC increased 31% while population access to HLTC increased only 6.9%. HLTC designation is likely driven by factors other than population need. To optimize efficiency and decrease potential oversupply, the designation process should include population level metrics. GIS methodology can be an effective tool to assess optimal placement. LEVEL OF EVIDENCE: Level IV.