M. P. Jarman1, T. Uribe-Leitz1, Z. G. Hashmi1, A. Salim1,2, A. H. Haider1,2 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Brigham And Women’s Hospital,Division Of Trauma, Burns, And Critical Care Surgery,Boston, MA, USA
Introduction: Trauma centers (TCs) in the US are geographically concentrated in urban regions and are not distributed according to population needs. This unequal distribution has created barriers in access to trauma care for large segments of the population. The objective of this study is to identify geographic regions in need of additional trauma centers in the US and demonstrate national application of the American College of surgeons (ACS) Needs Based Assessment of Trauma Systems (NBATS) areas using readily available secondary data.
Methods: Using 20 State Inpatient Datasets from the 2014 Healthcare Cost and Utilization Project, we identified severely injured patients (Injury Severity Score ≥ 16) treated at TCs (Level I/II/III) and non-TCs. We then aggregated injury incidence to the Hospital Referral Regions (HRR) level, and linked incidence with data from the American Hospital Association Annual Survey, the Dartmouth Atlas of Health Care, and the American Trauma Association Trauma Information Exchange Program. We then used multinomial logistic regression models to estimate HRR-level injury incidence in the remaining 30 states. We applied the ACS NBATS tools to the 306 HRRs in the 48 Contiguous United States and identified the number of additional Level I/II TCs needed in each region to care for the expected volume of severely injured patients.
Results: Of the 306 HRRs examined, we identified 115 (37.6%) as needing additional TCs (Figure), including 18 (5.9%) without existing Level I/II TCs. Of the HRRs in need of additional resources, 43 (37.4%) needed one additional TC to meet projected demand for trauma care, 51 (44.3%) needed two additional TCs, 15 (13.0%) needed three additional TCs, and 6 (5.2%) needed four additional TCs. HRRs in need of additional TCs were often geographically clustered, indicating the presence of complex trauma service areas with substantial geographic barriers to TC care. HRRs in need of additional trauma resources were found in all regions of the US, and included both large population centers with multiple existing TCs and rural regions with small patient populations.
Conclusion: This is the first study to demonstrate the feasibility of using public data sources to apply the ACS NBATS tool at a national level. We identified several regions in the US where increased trauma care resources are essential to meet population-based demand for trauma care. By examining the national distribution of trauma care needs, we can identify regional patterns in the distribution of TC resources, and support trauma system organizational decisions that optimize access to care. Based on our findings, we propose the use of HRRs to standardize projections of trauma service need when using the ACS NBATS tool.
