15.20 Level 1 Trauma Centers: More is Not Necessarily Better

Posted on January 18, 2016

J. C. He2, L. A. Kreiner2, N. Sajankila1, D. L. Allen3, J. A. Claridge2 1Case Western Reserve University School Of Medicine,Cleveland, OH, USA 2MetroHealth Medical Center,Department Of Surgery,Cleveland, OH, USA 3Northern Ohio Trauma System,Cleveland, OH, USA

Introduction:
The optimal number of level I trauma centers (L1TCs) in a region has not been elucidated. To begin addressing this, we compared mortalities for patients injured in counties or regions with 1 L1TC to those with more than 1 L1TC.

Methods:
Recent state trauma registry data from 2010-2012 were analyzed. Trauma patients with age ≥15 from counties or regions with L1TC were included in this study. Region was defined as a L1TC containing county and its neighboring counties. Counties boarding more than one L1TC containing county were excluded from analysis. Two analyses were performed. For the county-level analysis, counties containing only 1 L1TC were compared to counties with more than 1 L1TC. For the regional analysis, regions covered by only 1 L1TC were compared to regions covered by greater than 1 L1TC. The following patient subgroups were included a priori for both analyses: Injury Severity Score (ISS) ≥ 15, age ≥ 65, and trauma mechanisms.

Results:
A total of 54,471 patients were analyzed. Their mean age was 59; 90% had blunt injuries. Their median ISS was 5, and the overall mortality was 4.8%. Both the county-level and regional analyses showed that patients in counties or regions with only 1 L1TC were older (60 vs. 57, p<0.001), but had similar ISS as compared to patients in counties or regions with more than 1 L1TC. Counties and regions with only one L1TC also had less total number of trauma centers (3.5 vs. 3.8 and 2.4 vs. 2.9, respectively; all p <0.001) Mortalities for the county-level and regional analyses for all patients and patient subgroups are compared in Table 1. Multivariable logistic regression adjusting for age, ISS and trauma mechanism demonstrated that having more than 1 L1TC in a region was an independent predictor for death (Odds Ratio=1.2; 95% CI: 1.1-1.3, p<0.001).

Conclusion:
Despite older patients and fewer total number of trauma centers, counties and regions with only one L1TC had lower mortality. This suggests that having multiple L1TCs in a county or region may not lead to increased patient survival.