Best Of EAST #14: Trauma Center Access

The trauma group at MetroHealth in Cleveland has previously published a paper that examined the impact of Level I trauma centers in close proximity on their surrounding population. They have expanded this work to look at changes in the number of trauma centers of any level over a five year period and the populations that they serve across the US. The group was interested in elucidating the number of centers that opened in previously unserved areas, and the whether these areas were economically disadvantaged.

They used a list of state designated trauma centers maintained by the American Trauma Society. Level I and II centers were grouped together, as were Levels III through V. Census tracts around centers were categorized as “served” if the population surrounding it was within a 30 minute drive time of the center.

Here are the factoids:

  • The number of trauma centers increased by 256 to a total of 2140 in 2019, and 82% of these were Levels III-V
  • Nationwide coverage in terms of census tracts served increased from 75% to 80%
  • The increase in total population served was similar, rising from 76% to 79%
  • 91% of new Level I-II centers were in areas that were already served by other high level centers, and 86% of new Level III-V centers were in already served areas
  • New Level III-V centers were opened in areas with higher poverty than Level I-II centers (16% vs 13%)

The authors concluded that the numbers of trauma centers is increasing over time, but that more Level III-V centers are moving into underserved areas.

Bottom line: The authors have identified a novel way to suggest the financial motivations of opening trauma centers. When trauma systems were first implemented, there was an overall goal to provide coverage for the general population. But only a few states wrote guidelines that would attempt to evenly and equitably distribute new centers within and across counties.

The American College of Surgeons wrote a white paper and created a tool to assist in determining how many trauma centers were needed to serve a given population. Unfortunately, implementation of the tool was left to the states, and their legislatures had little interest in adding it to their system regulations after the fact.

So in some states, it’s like the wild, wild west with new centers opening almost next door to established and storied trauma hospitals. This abstract demonstrates that this phenomenon is real. But unfortunately, Pandora’s box was opened long ago and I don’t see that anything will change to address this situation in the foreseeable future.

Here are my questions for the authors and presenter:

  • Are the trends you identified general ones across the US, or are they focused in particular states?
  • Do you have any information on the impact of this trend on already existing trauma centers?
  • Can you speculate about what can be done to ameliorate this trend going forward?

This is a fascinating abstract about a non-clinical issue that has major implications for existing trauma programs (and especially certain states) well into the future.


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