Citation

Dooley JH, Ozdenerol E, Sharpe JP, Magnotti LJ, Croce MA, Fischer PE. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub.

Affiliation

University of Tennessee Health Science Center mhardee@uthsc.edu University of Memphis eozdenrl@memphis.edu University of Tennessee Health Science Center jsharpe6@uthsc.edu University of Tennessee Health Science Center lmagnotti@uthsc.edu University of Tennessee Health Science Center mcroce@uthsc.edu University of Tennessee Health Science Center pfischer@uthsc.edu.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002463

PMID

31389919

Abstract

INTRODUCTION: In 2015, the American College of Surgeons Committee on Trauma introduced the Needs-Based Assessment of Trauma Systems (NBATS) tool to quantify the optimal number of trauma centers for a region. While useful, more focus was required on injury population, distribution, and transportation systems. Therefore, NBATS-2 was developed utilizing advanced geographical modeling. The purpose of this study was to evaluate NBATS-2 in a large regional trauma system.

METHODS: Data from all injured patients from 2016-2017 with an ISS > 15 was collected from the trauma registry of the existing (legacy) center. Injury location and demographics were analyzed by zip code. A regional map was built using US census data to include hospital and population demographic data by zip code. Spatial modeling was conducted using ArcGIS to estimate an area within a 45-minute drive to a trauma center.

RESULTS: A total of 1,795 severely injured patients were identified across 54 counties in the tri-state region. 48% of the population and 58% of the injuries were within a 45-minute drive of the legacy trauma center. With the addition of another urban center, injured and total population coverage increased by only 1% while decreasing the volume to the existing center by 40%. However, the addition of two rural trauma centers increased coverage significantly to 62% of the population and 71% of the injured (p< 0.001). The volume of the legacy center was decreased by 25%, but the self-pay rate increased by 16%.

CONCLUSIONS: The geospatial modeling of NBATS-2 adds a new dimension to trauma system planning. This study demonstrates how geospatial modeling applied in a practical tool can be incorporated into trauma system planning at the local level and used to assess changes in population and injury coverage within a region, as well as potential volume and financial implications to a current system. LEVEL OF EVIDENCE: Level V STUDY TYPE: Observational.

Language: en