TY - JOUR PY - 2022// TI - Do new trauma centers provide needed or redundant access? A nationwide analysis JO - Journal of trauma and acute care surgery A1 - Ferre, Alexandra C. A1 - Curtis, Jacqueline A1 - Flippin, J. Alford A1 - Claridge, Jeffrey A. A1 - Tseng, Esther S. A1 - Brown, Laura R. A1 - Ho, Vanessa P. SP - ePub EP - ePub VL - ePub IS - ePub N2 - BACKGROUND: Our prior research has demonstrated that increasing the number of trauma centers (TCs) in a state does not reliably improve state-level injury-related mortality. We hypothesized that many new TCs would serve populations already served by existing TCs, rather than in areas without ready TC access. We also hypothesized that new TCs would also be less likely to serve economically disadvantaged populations.

METHODS: All state-designated adult TCs registered with the American Trauma Society in 2014 and 2019 were mapped using ArcGIS Pro. TCs were grouped as Level 1-2 (Lev12) or level 3-5 (Lev345). We also obtained census tract-level data (73,666 tracts), including population counts and % of population below the federal poverty threshold. Thirty-minute drive-time areas were created around each TC. Census tracts were considered "served" if their geographic centers were located within a 30-minute drive-time area to any TC. Data were analyzed at the census tract-level.

RESULTS: 2140 TCs were identified in 2019, with 256 new TCs and 151 TC closures. 82% of new TC were Level 3-5. Nationwide, coverage increased from 75.3% of tracts served in 2014 to 78.1% in 2019, representing an increased coverage from 76.0% to 79.4% of the population. New TC served 17,532 tracts, of which 87.3% were already served. New Lev12 TCs served 9,100 tracts, of which 91.2% were already served; New Lev345 TCs served 15,728 tracts, of which 85.9% were already served. Of 2,204 newly served tracts, those served by Lev345 TCs had higher mean % poverty compared with those served by Lev12 TCs (15.7% vs 13.2% poverty, p < 0.05).

DISCUSSION: Overall, access to trauma care has been improving in the United States. However, the majority of new TCs opened in locations with pre-existing access to trauma care. Nationwide, Level 3, 4, and 5 TCs have been responsible for expanding access to underserved populations. LEVEL OF EVIDENCE: Epidemiological, Level III.

Language: en

LA - en SN - 2163-0755 UR - http://dx.doi.org/10.1097/TA.0000000000003652 ID - ref1 ER -