Urban trauma centers: not quite dead yet

Area of Science:

• Trauma Surgery
• Public Health
• Healthcare Management

Background:

• Urban trauma centers face viability questions due to decreased violent crime and increased nonoperative management.
• Surgeon workload and productivity in these centers may be impacted.

Purpose of the Study:

• To examine changing patient characteristics admitted to an urban Level I trauma center over five years.
• To assess factors influencing trauma surgeon utilization and productivity.

Main Methods:

• Review of trauma registry admissions from January 1995 to December 1999.
• Data collection on demographics, injury mechanisms, severity, operations, and lengths of stay.
• Analysis of trends in patient characteristics and surgical interventions.

Main Results:

• Admissions decreased by 23%, with fewer general unit admissions and more intensive care unit (ICU) admissions.
• Mean patient age and Injury Severity Score increased significantly.
• Gunshot wound admissions dropped 45%, but operative rates for these patients rose 17%; general surgeon operative productivity remained stable.

Conclusions:

• Despite declining admissions, urban trauma centers remain viable and efficient.
• Centers are effectively managing an increasing volume of older, more severely injured patients requiring complex care.
• Trauma surgeon operative productivity is sustained, indicating continued essential service provision.