S. Ponciano1, B. Cordy1, A. Meraz1, C. Wang1, J. Mason2, Y. Korgaonkar2, J. He1 1University of Arizona School of Medicine Phoenix, Phoenix, AZ, USA 2University Of Arizona, School Of Geography, Development, And Environment, Tucson, AZ, USA
Introduction:
From 2007-2020, 45 trauma centers (TCs) were added to the state trauma system. This study uses state trauma registry to analyze effects of TC proliferation on patient outcomes and proposes a geospatial based TC expansion.
Methods:
Patients age ≥15 in the state trauma registry from 2007-2020 were queried for demographic, injury, and outcome variables. These were compared across 2007 (PRE) and 2020 (POST). Multivariate logistic regression was used to assess predictors of mortality. Subgroup analyses were done for geriatrics (age ≥65), Injury Severity Score (ISS) >15, and trauma mechanisms. Geospatial analyses were used to find potential TC locations based on factors such as distance to highway ramps and existing TCs. Service areas where a patient can be transported to a TC within 60 minutes by ground ambulance were delineated.
Results:
74,384 adults were included in the study, 40% female and 32% geriatric. The median ISS was 5 and inpatient mortality was 2.9%. Comparing the two cohorts, POST had more female (32.4% vs 42.7%; p < 0.001), geriatric (9.4% vs 41.7%; p < 0.001), and blunt trauma (88.3% vs 92.1%; p < 0.001) patients; ISS remained similar. POST had more interfacility transfers (1.6% vs 17.6%; p < 0.001), longer total length of stay (LOS, 0.3 vs 1.1; p < 0.001), ICU LOS (2 vs 3; p < 0.001), and ventilator-dependent days (0 vs 3; p < 0.001). Mortality decreased by 0.7% (3.4% vs 2.7%; p < 0.001). After adjusting for demographic differences, POST was predictive of death in all groups analyzed (OR: 1.4, CI:1.3-1.5, p < 0.001), except for geriatric subgroup, where POST was not predictive of mortality
Service area analysis showed that 66% of the total area covered by existing TCs is redundant. Currently, existing TCs cover 28% of the state (Figure 1). Geospatial analysis identified 4 potential TC locations. Coverage increased to 30.6% when the 2 TCs located farthest away from existing TCs were added and to 30.8% when all 4 locations were added.
Conclusion:
Despite advances in trauma care and 45 more TCs, POST had minimal reduction of mortality and was an independent predictor of death. Current TCs provide redundant trauma coverage. Geospatial analysis can propose potential TC locations that may increase trauma coverage.