The Impact of Geographic Distribution on Trauma Center Outcomes: Do Center Outcomes Vary by Region?

Elkbuli, Adel; Dowd, Brianna; Flores, Rudy; McKenney, Mark

doi:10.1016/j.jss.2020.03.009

Cited by 6 publications

(13 citation statements)

References 23 publications

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“…Of note, both Hispanic and non‐Hispanic patients had longer median times of EMS response than the expected median from previously published national medians [18]. Ultimately, the geographical location of farmers in rural areas likely places them at a disadvantage regardless of ethnicity and requires further investigation [19, 20]. Other studies have identified similar disparities in care provided to rural patients such as management of stroke [21].…”

Section: Discussionmentioning

confidence: 93%

Hispanic Farmers Experience Shorter EMS Response Times but Longer Emergency Department Length of Stay Following Occupational Injuries

et al. 2022

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Background Agriculture has the highest rate of fatal injuries by sector. Hispanic workers also experience more fatal work injuries than every other minority group combined. Pre‐hospital and initial trauma evaluation represent an important marker to understand the impact of a trauma system. We sought to investigate whether Hispanic agricultural workers in the United States (US) experience disparities following traumatic occupational injuries in terms of pre‐hospital and emergency department care. Methods We retrospectively analyzed the National Trauma Data Bank from 2012–2016 to understand differences between Hispanic and non‐Hispanic farmers in Emergency Medical Services (EMS) response and transport times (minutes), transport mode, transfer rates, presentation to University or Level I trauma hospitals, Injury Severity Scores (ISS), length of stay (LOS) in the emergency department (ED, minutes) or hospital (days), need for the operating room (OR), admittance to the Intensive Care Unit (ICU), and mortality. Results A total of 6,161 farmers were included in our analyses (median age 47 years, females 7.0%). Multivariable analyses indicate differences regarding EMS response, EMS transport, and LOS in the ED. Rates of admission to the ICU, surgical operations, days on a ventilator, discharge from the hospital with supportive care, and mortality did not differ between groups. Conclusions Non‐Hispanic patients have longer median EMS response and total transport times. Hispanic patients have longer median LOS in the ED. However, the lack of significant differences in management variables other than EMS times and ED LOS indicate an equitable delivery of trauma care once patients were transferred from the ED.

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Section: Discussionmentioning

confidence: 93%

Hispanic Farmers Experience Shorter EMS Response Times but Longer Emergency Department Length of Stay Following Occupational Injuries

et al. 2022

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“…Table 2 summarizes the general characteristics of the 32 studies [ 16 , 24 – 54 ]. Of the 32 studies, one [ 26 ] used data obtained from insurance companies, while all other used representative regional and national data; specifically, nine [ 16 , 31 , 34 , 40 – 42 , 46 , 48 , 51 ] used national data and one [ 32 ] used cross-national data, and the remainder [ 24 – 30 , 33 , 35 – 39 , 43 – 45 , 47 , 49 , 50 , 52 – 54 ] used regional data. Of the 32 articles, there was one systematic review [ 38 ] and one scoping review [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…The studies were assigned to one of five categories for assessment: 16 [ 27 , 29 , 30 , 33 , 35 – 37 , 40 , 43 – 45 , 49 – 53 ] in individual, four [ 16 , 39 , 41 , 42 ] in regional, 10 [ 24 , 26 , 28 , 31 , 32 , 34 , 46 – 48 , 54 ] in individual and regional, one [ 38 ] in systematic review, and one [ 25 ] in scoping review. The sample population sizes ranged from 614 to 8,673,213 subjects.…”

Section: Resultsmentioning

confidence: 99%

Relationships between trauma death, disability, and geographic factors: a systematic review

Hwang¹,

Jeong²,

Jo³

2023

Clin Exp Emerg Med

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Objective Trauma is a global health problem. The causes of trauma-related deaths are diverse and may depend in part on socioeconomic and geographical factors; however, there have been few studies addressing such relationships. The aim of this study was to investigate the relationships between trauma and geographical factors in order to support policy recommendations to reduce trauma-related deaths and disability.Methods In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched international and Korean databases to retrieve relevant literature published between 2000 and 2020.Results Thirty-two studies showed a positive relationship between the outcomes of major trauma and geographical factors. The study investigated regional factors including economic factors such as size of urban areas, gross domestic product, and poverty rate, as well as hospital parameters, such as presence of trauma centers and number of hospital beds. There was a tendency toward higher mortality rates in rural and low-income areas, and most of the studies reported that the presence of trauma centers reduced trauma-related mortality rates.Conclusion Our study showed that geographic factors influence trauma outcomes. The findings suggest geographical considerations be included in care plans to reduce death and disability caused by trauma.

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“…Relatedly, previous literature has also shown that the Southern and Western US regions experience significantly higher-adjusted all-cause mortality and greater degrees of trauma surgeon shortages compared to the Midwest and Northeast. 25,26 The combination of being an at-risk county and receiving patients from neighboring counties may serve to overwhelm current TCs and could indicate that additional TCs may be needed to treat the injury burden. 25 Therefore, a closer examination of the criteria necessary for attainment of ACSCOT-verification and state-designation of TCs is required to determine possible challenges and areas for criteria refinement, which may allow hospital systems to more appropriately meet the trauma care needs of the community.…”

Section: Discussionmentioning

confidence: 99%

Nationwide Analysis of the Distribution of Level 1 and Level 2 Trauma Centers Per Population Growth and Motor Vehicle Collision Injuries/Fatalities Utilizing Geographic Information Systems Mapping Technology

et al. 2023

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Background: Trauma centers (TCs) improve patient outcomes. Few investigations detail the US geographical distribution of Level 1 and 2 TCs (L1TCs, L2TCs) regarding motor vehicle collision (MVC) injuries/fatalities. Objective: We utilized Geographic Information Systems mapping to investigate the distribution of L1TCs and L2TCs in relation to population growth, MVC injuries, and MVC fatalities at the county and regional level to identify any disparities in access to trauma care. Methods: A cross-sectional analysis of L1TC and L2TC distribution, MVC injuries/fatalities, and population growth from 2010 to 2018. Information was gathered at the county and region level for young adults (aged 15–44), middle-aged adults (45–64), and elderly (≥65). Results: A total of 263 L1TCs across 46 states and 156 counties and 357 L2TCs across 44 states and 255 counties were identified. The mean distance between L1TCs and L2TCs is 28.3 miles and 31.1 miles, respectively. Seven counties were identified as being at-risk, all in the Western and Southern US regions that experienced ≥10% increase in population size, upward trends in MVC injuries, and upward trends MVC fatalities across all age groups. Conclusions: Seven US counties containing ≤2 ACSCOT-verified and/or state-designated L1TCs or L2TCs experienced a 10% increase in population, MVC injuries, and MVC fatalities across young, middle-aged and elderly adults from 2010 to 2018. This study highlights chronic disparities in access to trauma care for MVC patients. Evaluation of state limitations regarding the distribution of L1TCs and L2TCs, frequent evaluation of local and regional trauma care needs, and strategic interventions to improve access to trauma care may improve patient outcomes for heavily burdened counties.

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The Impact of Geographic Distribution on Trauma Center Outcomes: Do Center Outcomes Vary by Region?

Cited by 6 publications

References 23 publications

Hispanic Farmers Experience Shorter EMS Response Times but Longer Emergency Department Length of Stay Following Occupational Injuries

Hispanic Farmers Experience Shorter EMS Response Times but Longer Emergency Department Length of Stay Following Occupational Injuries

Relationships between trauma death, disability, and geographic factors: a systematic review

Nationwide Analysis of the Distribution of Level 1 and Level 2 Trauma Centers Per Population Growth and Motor Vehicle Collision Injuries/Fatalities Utilizing Geographic Information Systems Mapping Technology

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