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. 2019 Jan;228(1):9-20.
doi: 10.1016/j.jamcollsurg.2018.09.015. Epub 2018 Oct 22.

Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

Zain G Hashmi  1 , Molly P Jarman  2 , Tarsicio Uribe-Leitz  2 , Eric Goralnick  3 , Craig D Newgard  4 , Ali Salim  2 , Edward Cornwell 3rd  5 , Adil H Haider  2
Affiliations

Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

Zain G Hashmi et al. J Am Coll Surg. 2019 Jan.

Abstract

Background: Timely access to trauma center (TC) care is critical to achieve "Zero Preventable Deaths after Injury." However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality, and timely access to trauma center care.

Study design: We analyzed state-level analysis of adult trauma deaths reported to the CDC Wide-ranging Online Data for Epidemiological Research (WONDER) (1999 to 2016). Correlation between the state-level pre-hospital:in-hospital death ratio (PH:IH), the proportion of population with access to Level-I/II TC, and the age-adjusted mortality rate (AAMR) was determined. Population proportion with timely access to TC care was compared between states with a high pre-hospital death burden vs all other states. National estimates of potentially preventable pre-hospital deaths were calculated.

Results: There were 1,949,375 trauma deaths analyzed. Overall, 1.19 times more deaths occurred pre-hospital (49%, n = 960,554) than in-hospital (42%, n = 810,387). States with better TC access had a lower AAMR (r = -0.71, p < 0.05) and relatively fewer pre-hospital deaths (r = -0.64, p < 0.05); states with higher AAMR had relatively more pre-hospital deaths (r = 0.70, p < 0.05). States with a high pre-hospital death burden had a lower proportion of population with access to Level-I/II TC within 1 hour vs all other states (63.2% vs 90.2%, p < 0.001). If all states had the same PH:IH death ratio as those among the best quartile for access, 129,213 pre-hospital deaths may potentially have been averted.

Conclusions: States with poor TC access have more pre-hospital deaths, which contribute to higher overall injury mortality. This suggests that in these states, improving TC access will be critical to achieve "Zero Preventable Deaths after Injury."

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