E. E. Freeh1, G. M. Niziolek1, R. M. Boudreau1, J. Baker1, D. A. Millar1, A. T. Makley1, T. A. Pritts1, M. D. Goodman1 1University Of Cincinnati,Department Of Surgery, College Of Medicine,Cincinnati, OH, USA
Introduction: With the number of traumatic injuries continuing to increase in the United States, new trauma centers are opening across the country. In July 2013, a level III trauma center affiliated with the only level I trauma center in a metropolitan region was opened approximately 25 miles away. The goal of this study was to evaluate the impact and outcomes of opening a level III trauma center within a health care system while also assessing the effect this opening had on the region’s level I trauma center volume.
Methods: A retrospective review of the trauma registries at the level I and the level III centers was undertaken from July 2013 to December 2017. Patients were grouped by their zip code of residence and the number of patients from each zip code that presented to both trauma centers over time was examined. The median length of stay and injury severity score of patients that presented to the level III was also tracked over time.
Results: A total of 3,172 patients presented for a trauma surgery evaluation at the level III trauma center during the study period. The number of patients that presented monthly gradually rose from 36 patients in July 2013 to 80 patients in June 2017. Half of the patients (49.5%) evaluated at the level III center were residents from one of three zip codes immediately adjacent to the level III trauma center. Admissions from those zip codes gradually increased over the study period. Another quarter (27.8%) of patients that presented to the level III center were residents of one of 8 zip codes located within a 20 mile radius of the trauma center and admissions from this demographic remained stable over the study period. Interestingly, the number of patients that presented to the level I from those 11 zip codes remained stable over the study period. A gradual increase over time in the percent of trauma service admissions at the Level III trauma center was mirrored by a decrease over time in injured patients who were discharged from the emergency department. Over the course of the study period, the median ISS at the Level III trauma center increased from 5 to 8.5 (p<0.05) between the first 6 month period and that last 6 month period.
Conclusion: Opening a level III trauma center has allowed augmentation of the trauma services provided within a health care system. While volume related metrics may serve as an initial indicator of regional trauma volume, ensuring appropriate triage, transfer, and quality of care remain integral to the integrity of a regional trauma system as patients with increasing injury severity are evaluated at the level III trauma center.