@article{ref1,
title="Access delayed is access denied: relationship between access to trauma center care and pre-hospital death",
journal="Journal of the American Academy of Surgeons",
year="2019",
author="Hashmi, Zain G. and Jarman, Molly P. and Uribe-Leitz, Tarsicio and Goralnick, Eric and Newgard, Craig D. and Salim, Ali and Cornwell, Edward E. and Haider, Adil H.",
volume="228",
number="1",
pages="9-20",
abstract="BACKGROUND: Timely access to trauma center(TC) care is critical to achieve &quot;Zero Preventable Deaths After Injury.&quot; 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. <br><br>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. <br><br>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 &quot;Zero Preventable Deaths After Injury.&quot;<br><br>Copyright © 2018. Published by Elsevier Inc.<p /> <p>Language: en</p>",
language="en",
issn="1072-7515",
doi="10.1016/j.jamcollsurg.2018.09.015",
url="http://dx.doi.org/10.1016/j.jamcollsurg.2018.09.015"
}