Citation

Hashmi ZG, Jarman MP, Uribe-Leitz T, Goralnick E, Newgard CD, Salim A, Cornwell EE, Haider AH. J. Am. Coll. Surg. 2019; 228(1): 9-20.

Affiliation

Center for Surgery and Public Health: Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham & Women's Hospital, Boston, MA.

Copyright

(Copyright © 2019, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2018.09.015

PMID

30359830

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: State-level analysis of adult trauma deaths reported to CDC WONDER (1999-2016). Correlation between state-level pre-hospital:in-hospital death ratio(PH:IH), proportion of population with access to level-I/II TC and 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 versus all other states. National estimates of potentially preventable pre-hospital deaths were calculated.

RESULTS: 1,949,375 trauma deaths were analyzed. Overall, 1.19 times more deaths occurred pre-hospital [49%, n=960,554] than in-hospital [42%(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 versus all other states (63.2% versus 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.

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

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Pre-hospital; access to care; preventable mortality; trauma