BACKGROUND: Regionalized trauma care improves outcomes; however, access to care is not uniform across the United States. The objective was to evaluate whether geographic distribution of trauma centers correlates with injury mortality across state trauma systems. METHODS: Level I or II trauma centers in the contiguous United States were mapped. State-level age-adjusted injury fatality rates per 100,000 people were obtained and evaluated for spatial autocorrelation. Nearest neighbor ratios (NNRs) were generated for each state. A NNR less than 1 indicates clustering, while a NNR greater than 1 indicates dispersion. NNRs were tested for difference from random geographic distribution. Fatality rates and NNRs were examined for correlation. Fatality rates were compared between states with trauma center clustering versus dispersion. Trauma center distribution and population density were evaluated. Spatial-lag regression determined the association between fatality rate and NNR, controlling for state-level demographics, population density, injury severity, trauma system resources, and socioeconomic factors. RESULTS: Fatality rates were spatially autocorrelated (Moran's I = 0.35, p < 0.01). Nine states had a clustered pattern (median NNR, 0.55; interquartile range [IQR], 0.48-0.60), 22 had a dispersed pattern (median NNR, 2.00; IQR, 1.68-3.99), and 10 had a random pattern (median NNR, 0.90; IQR, 0.85-1.00) of trauma center distribution. Fatality rate and NNR were correlated (ρ = 0.34, p = 0.03). Clustered states had a lower median injury fatality rate compared with dispersed states (56.9 [IQR, 46.5-58.9] vs. 64.9 [IQR, 52.5-77.1]; p = 0.04). Dispersed compared with clustered states had more counties without a trauma center that had higher population density than counties with a trauma center (5.7% vs. 1.2%, p < 0.01). Spatial-lag regression demonstrated that fatality rates increased by 0.02 per 100,000 persons for each unit increase in NNR (p < 0.01). CONCLUSION: Geographic distribution of trauma centers correlates with injury mortality, with more clustered state trauma centers associated with lower fatality rates. This may be a result of access relative to population density. These results may have implications for trauma system planning and require further study to investigate underlying mechanisms. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
BACKGROUND: Regionalized trauma care improves outcomes; however, access to care is not uniform across the United States. The objective was to evaluate whether geographic distribution of trauma centers correlates with injury mortality across state trauma systems. METHODS: Level I or II trauma centers in the contiguous United States were mapped. State-level age-adjusted injury fatality rates per 100,000 people were obtained and evaluated for spatial autocorrelation. Nearest neighbor ratios (NNRs) were generated for each state. A NNR less than 1 indicates clustering, while a NNR greater than 1 indicates dispersion. NNRs were tested for difference from random geographic distribution. Fatality rates and NNRs were examined for correlation. Fatality rates were compared between states with trauma center clustering versus dispersion. Trauma center distribution and population density were evaluated. Spatial-lag regression determined the association between fatality rate and NNR, controlling for state-level demographics, population density, injury severity, trauma system resources, and socioeconomic factors. RESULTS: Fatality rates were spatially autocorrelated (Moran's I = 0.35, p < 0.01). Nine states had a clustered pattern (median NNR, 0.55; interquartile range [IQR], 0.48-0.60), 22 had a dispersed pattern (median NNR, 2.00; IQR, 1.68-3.99), and 10 had a random pattern (median NNR, 0.90; IQR, 0.85-1.00) of trauma center distribution. Fatality rate and NNR were correlated (ρ = 0.34, p = 0.03). Clustered states had a lower median injury fatality rate compared with dispersed states (56.9 [IQR, 46.5-58.9] vs. 64.9 [IQR, 52.5-77.1]; p = 0.04). Dispersed compared with clustered states had more counties without a trauma center that had higher population density than counties with a trauma center (5.7% vs. 1.2%, p < 0.01). Spatial-lag regression demonstrated that fatality rates increased by 0.02 per 100,000 persons for each unit increase in NNR (p < 0.01). CONCLUSION: Geographic distribution of trauma centers correlates with injury mortality, with more clustered state trauma centers associated with lower fatality rates. This may be a result of access relative to population density. These results may have implications for trauma system planning and require further study to investigate underlying mechanisms. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Authors: Michael J Widener; Zac Ginsberg; Daniel Schleith; Douglas J Floccare; Jon Mark Hirshon; Samuel Galvagno Journal: Aerosp Med Hum Perform Date: 2015-07 Impact factor: 1.053
Authors: David Gomez; Barbara Haas; Aristithes G Doumouras; Brandon Zagorski; Joel Ray; Gordon Rubenfeld; Barry A McLellan; Donald M Boyes; Avery B Nathens Journal: Ann Surg Date: 2013-01 Impact factor: 12.969
Authors: Zachary J Rhinehart; Francis X Guyette; Jason L Sperry; Raquel M Forsythe; Alan Murdock; Louis H Alarcon; Andrew B Peitzman; Matthew R Rosengart Journal: Ann Surg Date: 2013-06 Impact factor: 12.969
Authors: Jan O Jansen; Jonathan J Morrison; Handing Wang; Robin Lawrenson; Gerry Egan; Shan He; Marion K Campbell Journal: J Trauma Acute Care Surg Date: 2014-04 Impact factor: 3.313
Authors: Joshua B Brown; Matthew R Rosengart; Timothy R Billiar; Andrew B Peitzman; Jason L Sperry Journal: J Trauma Acute Care Surg Date: 2017-07 Impact factor: 3.313
Authors: Quanhong Zhou; Matthew R Rosengart; Timothy R Billiar; Andrew B Peitzman; Jason L Sperry; Joshua B Brown Journal: JAMA Surg Date: 2017-04-01 Impact factor: 14.766
Authors: Peter C Jenkins; Lava Timsina; Patrick Murphy; Christopher Tignanelli; Daniel N Holena; Mark R Hemmila; Craig Newgard Journal: Ann Surg Date: 2022-02-01 Impact factor: 13.787
Authors: Heather M Grossman Verner; Brian A Figueroa; Marcos Salgado Crespo; Manuel Lorenzo; Joseph D Amos Journal: Trauma Surg Acute Care Open Date: 2021-08-04
Authors: Lynne Moore; Howard Champion; Pier-Alexandre Tardif; Brice-Lionel Kuimi; Gerard O'Reilly; Ari Leppaniemi; Peter Cameron; Cameron S Palmer; Fikri M Abu-Zidan; Belinda Gabbe; Christine Gaarder; Natalie Yanchar; Henry Thomas Stelfox; Raul Coimbra; John Kortbeek; Vanessa K Noonan; Amy Gunning; Malcolm Gordon; Monty Khajanchi; Teegwendé V Porgo; Alexis F Turgeon; Luke Leenen Journal: World J Surg Date: 2018-05 Impact factor: 3.352
Authors: Evelyn I Truong; Vanessa P Ho; Esther S Tseng; Colette Ngana; Jacqueline Curtis; Eric T Curfman; Jeffrey A Claridge Journal: J Trauma Acute Care Surg Date: 2021-07-01 Impact factor: 3.697
Authors: Agnieszka Genowska; Jacek Jamiołkowski; Krystyna Szafraniec; Justyna Fryc; Andrzej Pająk Journal: Int J Environ Res Public Health Date: 2021-05-22 Impact factor: 3.390
Authors: Bayu Satria Wiratama; Ping-Ling Chen; Chung-Jen Chao; Ming-Heng Wang; Wafaa Saleh; Hui-An Lin; Chih-Wei Pai Journal: Int J Environ Res Public Health Date: 2021-03-15 Impact factor: 3.390