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. 2022 Sep 1;93(3):347-352.
doi: 10.1097/TA.0000000000003652. Epub 2022 May 30.

Do new trauma centers provide needed or redundant access? A nationwide analysis

Alexandra C Ferre  1 , Jacqueline Curtis, J Alford Flippin, Jeffrey A Claridge, Esther S Tseng, Laura R Brown, Vanessa Phillis Ho
Affiliations

Do new trauma centers provide needed or redundant access? A nationwide analysis

Alexandra C Ferre et al. J Trauma Acute Care Surg. .

Abstract

Background: Our prior research has demonstrated that increasing the number of trauma centers (TCs) in a state does not reliably improve state-level injury-related mortality. We hypothesized that many new TCs would serve populations already served by existing TCs, rather than in areas without ready TC access. We also hypothesized that new TCs would also be less likely to serve economically disadvantaged populations.

Methods: All state-designated adult TCs registered with the American Trauma Society in 2014 and 2019 were mapped using ArcGIS Pro (ESRI Inc., Redlands, CA). Trauma centers were grouped as Level 1 or 2 (Lev12) or Level 3, 4 or 5 (Lev345). We also obtained census tract-level data (73,666 tracts), including population counts and percentage of population below the federal poverty threshold. Thirty-minute drive-time areas were created around each TC. Census tracts were considered "served" if their geographic centers were located within a 30-minute drive-time area to any TC. Data were analyzed at the census tract level.

Results: A total of 2,140 TCs were identified in 2019, with 256 new TCs and 151 TC closures. Eighty-two percent of new TCs were Levels 3 to 5. Nationwide, coverage increased from 75.3% of tracts served in 2014 to 78.1% in 2019, representing an increased coverage from 76.0% to 79.4% of the population. New TC served 17,532 tracts, of which 87.3% were already served. New Lev12 TCs served 9,100 tracts, of which 91.2% were already served; new Lev345 TCs served 15,728 tracts, of which 85.9% were already served. Of 2,204 newly served tracts, those served by Lev345 TCs had higher mean percentage poverty compared with those served by Lev12 TCs (15.7% vs. 13.2% poverty, p < 0.05).

Discussion: Overall, access to trauma care has been improving in the United States. However, the majority of new TCs opened in locations with preexisting access to trauma care. Nationwide, Levels 3, 4, and 5 TCs have been responsible for expanding access to underserved populations.

Level of evidence: Prognostic and Epidemiologic; Level IV.

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Conflict of interest statement

Conflicts of Interest:

Dr. Ho spouse is a consultant for Medtronic, Zimmer Biomet, Atricure, and Astra Zeneca.

Drs. Ferre, Curtis, Flippin, Claridge, Tseng, and Brown have no financial ties to disclose.

Figures

Figure 1.
Figure 1.
Trauma Center Access by Census Tract, 2014 and 2019 Map of the United States, contiguous 48 states. Light gray color represents census tracts which were never served Dark gray color represents census tracts which were always served Yellow color represents census tracts which lost access between 2014 and 2019 Blue color represents census tracts which gained access between 2014 and 2019 Green circles represent new trauma centers in already served tracts New trauma centers in newly served tracts are not specifically shown as these are co-located with blue census tracts
See this image and copyright information in PMC

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