@article{ref1,
title="Level one trauma center proliferation may worsen patient outcomes",
journal="American surgeon",
year="2024",
author="Zhou, Michael and Norton, Taylor W. and Rupp, Kelsey and Paxton, Rebecca J. and Wang, Michele S. and Rehman, Nisha S. and He, Jack",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: From 2013 to 2020, Arizona state trauma system expanded from seven to thirteen level 1 trauma centers (L1TCs). This study utilized the state trauma registry to analyze the effect of L1TC proliferation on patient outcomes. <br><br>METHODS: Adult patients age≥15 in the state trauma registry from 2007-2020 were queried for demographic, injury, and outcome variables. These variables were compared across the 2 time periods: 2007-2012 as pre-proliferation (PRE) and 2013-2020 as post-proliferation (POST). Multivariate logistic regression was performed to assess independent predictors of mortality. Subgroup analyses were done for Injury Severity Score (ISS)≥15, age≥65, and trauma mechanisms. <br><br>RESULTS: A total of 482,896 trauma patients were included in this study. 40% were female, 29% were geriatric patients, and 8.6% sustained penetrating trauma. The median ISS was 4. Inpatient mortality overall was 2.7%. POST consisted of more female, geriatric, and blunt trauma patients (P <.001). Both periods had similar median ISS. POST had more interfacility transfers (14.5% vs 10.3%, P <.001). Inpatient, unadjusted mortality decreased by.5% in POST (P <.001). After adjusting for age, gender, ISS, and trauma mechanism, being in POST was predictive of death (OR: 1.4, CI:1.3-1.5, P <.001). This was consistent across all subgroups except for geriatric subgroup, which there was no significant correlation. <br><br>DISCUSSION: Despite advances in trauma care and almost doubling of L1TCs, POST had minimal reduction of unadjusted mortality and was an independent predictor of death. <br><br>RESULTS suggest increasing number of L1TCs alone may not improve mortality. Alternative approaches should be sought with future regional trauma system design and implementation.<p /> <p>Language: en</p>",
language="en",
issn="0003-1348",
doi="10.1177/00031348241244647",
url="http://dx.doi.org/10.1177/00031348241244647"
}