Disparities in Trauma Center Access Despite Increasing Utilization: Data From California, 1999 to 2006

Abstract

Background-While efforts have been made to address disparities in access to trauma care in the past decade, there is little evidence to show if utilization has changed. We use patient-level data to describe the changes in utilization of trauma centers in an eight-year period in California. Results-The proportion of severe injuries admitted increased by 3.6% (p < 0.05), with a concomitant rise in the proportion of trauma patients admitted to trauma centers (TCs), from 39.3% (95% CI 39.0% -39.7%) to 49.7% (49.4% -50.0%). Within the severely injured with injury severity scores > 15, 82.4% were treated in a TC if they resided in a county with a TC, compared to 30.8% of patients who did not live in a county with a TC. After adjustment, patients living greater than 50 miles away from a TC still had a likelihood ratio of 0.11 (p<0.0001) of receiving care in a TC compared to those less than 10 miles away. Similarly, even severely injured patients not living in a county with a TC had a likelihood ratio of 0.35 (p<0.0001) of being admitted to a TC compared to those residing in counties with trauma centers. Methods-We Conclusion-Admissions toTCs for all categories of injury severity are increasing. There remains, however, a large disparity in TC care depending on geographical distance and availability of a TC within county.

The association of trauma center closures with increased inpatient mortality for injured patients

“…19,20 We also excluded patients with isolated hip fractures (ICD-9 codes 820–820.9; ISS=9), 21 as there is no evidence that they benefit from TC care. In addition, we excluded patients with missing e-codes, without which we could not reliably determine the mechanism of injury that we adjusted for in our models.…”

“…We also included hospital-level characteristics that have been shown to be associated with access to TCs and mortality, including whether or not there is a TC available within a patient’s county, urbanicity, and case-mix adjustment for patient severity. 19,32 Finally, we included year as a covariate to account for secular trends in trauma care.…”

The trade-offs in field trauma triage: A multiregion assessment of accuracy metrics and volume shifts associated with different triage strategies

“…8 However, the feasibility of reaching these benchmarks and the resulting implications for trauma systems remain unclear. Recent literature suggests that the benchmark for under-triage is not being met, [10][11][12][13][14][15] particularly among older adults, and it remains unknown whether the guidelines could be revised to meet these accuracy targets. It is also uncertain how changes in triage accuracy may impact the volume of injured patients transported to different types of hospitals.…”

Access to a Canadian provincial integrated trauma system: A population-based cohort study

“…A study conducted in United States showed that in inclusive trauma systems, access to level I and II TCs for severely injured patients range from 65 to 70% [30], which is consistent with our results. Injury severity, age, gender, and comorbidities have all been identified as independent predictors of access to TCs [9,17,19,31]. Excepted patients admitted for penetrant injuries, those admitted for motor a vehicle collision had higher access to TCs compared to other injury mechanisms.…”