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

Abstract

Background Trauma centers are an effective but costly element of the US health care infrastructure. Some level I and II trauma centers regularly incur financial losses when these high fixed costs are coupled with high burdens of uncompensated care for disproportionately young and uninsured trauma patients. As a result, they are at risk of reducing their services or closing. The impact of these closures on patient outcomes, however, has not been previously assessed. Methods We performed a retrospective study of all adult patient visits for injuries at Level I and II, non-federal trauma centers in California between 1999–2009. Within this population, we compared the in-hospital mortality of patients whose drive time to their nearest trauma center increased as the result of a nearby closure to those whose drive time did not increase using a multivariate logit-linked generalized linear model. Our sensitivity analysis tested whether this effect was limited to a two-year period following a closure. Results The odds of inpatient mortality increased by 21%(OR 1.21, 95% CI 1.04–1.40) among trauma patients who experienced an increased drive time to their nearest trauma center as a result of a closure. The sensitivity analyses showed an even larger effect in the two years immediately following a closure, during which patients with increased drive time had 29% higher odds of inpatient death (OR 1.29, 95% CI 1.11, 1.51). Conclusions Our results show a strong association between closure of trauma centers in California and increased mortality for patients with injuries who have to travel further for definitive trauma care. These adverse impacts were intensified within two years of a closure. Level of Evidence Level III, Prognostic and Epidemiological

Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study

“…This becomes increasingly important as trauma centers are closing more frequently in the United States and closures are related to profitability. 19,20 A recent study estimated that the annual cost of readiness for a trauma center is $2.7 million dollars, and coupling this cost with low rates of reimbursement and uninsured patients creates a financial burden on a trauma center to stay open. 20,21 Ultimately, closures of trauma centers are often related to financial constraints and can have a profound impact on patient care and outcomes.…”

“…19,20 A recent study estimated that the annual cost of readiness for a trauma center is $2.7 million dollars, and coupling this cost with low rates of reimbursement and uninsured patients creates a financial burden on a trauma center to stay open. 20,21 Ultimately, closures of trauma centers are often related to financial constraints and can have a profound impact on patient care and outcomes. Hsia et al identified a relationship between closure of trauma centers and increased mortality in patients suffering traumatic injuries as they have to travel further to receive treatment.…”

“…Hsia et al identified a relationship between closure of trauma centers and increased mortality in patients suffering traumatic injuries as they have to travel further to receive treatment. 20 A cost analysis comparing surgical management and conservative management of high-grade renal trauma is necessary to further elucidate the economic implications.…”

Acute pain from the perspective of minor trauma patients treated at the emergency unit

“…Among the types of acute pain, the most evaluated in healthcare services and scientifi c-academic studies are post-operative and those triggered by infl ammatory and infectious processes (7) . Truly, trauma pain does not have the same emphasis, despite that fact that, currently, the number of victims of external causes has been increasing (1)(2)(3) . Studies that seek to understand the diverse interfering and conditional factors of painful sensation are fundamental, since, according to the concept of pain employed by the scientifi c community lately, there is not always a direct relationship between tissue damage and pain (5)(6) and, as far as we know, knowledge of this area is still new.…”

“…Trauma, resulting from external causes, has been increasing the morbidity and mortality rate indices in various parts of the world (1)(2) , including in Brazil (3) . The deaths and hospitalizations due to external causes represent, currently, an important problem in public, economic and social health.…”